NPIMap

Organization Active NPI

Good Samaritan Clinic

  • Family Medicine Physician
  • Fort Smith, AR
National Provider Identifier
1144608746
Registry record updated May 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GOOD SAMARITAN CLINIC
Practice address
615 North B Street
Fort Smith, AR 72901
Phone
(479) 783-0233
NPI assigned
May 14, 2015
Last updated
May 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2015

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

Authorized official

Name
Evan Breedlove
Title
Administrator
Phone
(479) 783-0233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

615 North B Street
Fort Smith, AR 72901

Mailing address

615 North B Street
Fort Smith, AR 72901
Phone (479) 783-0233

National Provider Directory

National Provider Directory

Locations

615 N B St
Fort Smith, AR 72901
Phone (479) 783-0233

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431561600000",
    "number": "1144608746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 NORTH B STREET",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "72901",
            "telephone_number": "479-783-0233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 NORTH B STREET",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "72901",
            "telephone_number": "479-783-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2015-05-14",
        "status": "A",
        "authorized_official_last_name": "BREEDLOVE",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-783-0233"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; 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.