Basic Information
| Provider Information | |||||||||
| NPI: | 1063682276 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAMARITAN PACIFIC HEALTH SERVICES | ||||||||
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| OtherOrganizationName: | SAMARITAN MEDICAL EQUIPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 NW 9TH STREET | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973306173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417686768 | ||||||||
| FaxNumber: | 5417686774 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 NE HARNEY STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973652524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415744797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | BIGELOW | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5415741801 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.