Good Samaritan Free Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036088031 Issued in IL

Legal business name

GOOD SAMARITAN FREE CLINIC

Practice address

602 35TH Ave
Moline, IL 61265-6145

Phone

(309) 797-4688

Fax

(309) 797-6118

NPI assigned

Aug 28, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kerry Humes, M.D.

Title

Director

Phone

(309) 797-4688

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1114150893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 35TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656145",
            "telephone_number": "309-797-4688",
            "fax_number": "309-797-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 35TH AVE",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656145",
            "telephone_number": "309-797-4688",
            "fax_number": "309-797-6118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-28",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "HUMES",
        "authorized_official_first_name": "KERRY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "309-797-4688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036088031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Moline, IL
• Providers in Moline, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.