Basic Information
| Provider Information | |||||||||
| NPI: | 1720112139 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR.SAMIR FARAH MD,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E 34TH ST | ||||||||
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| City: | HIBBING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557462341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183626683 | ||||||||
| FaxNumber: | 2183626684 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 BURDICK EXPY W | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018525236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | JACOBSON | ||||||||
| AuthorizedOfficialFirstName: | MARCIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2183626761 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 3820 | ND | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 10322 | 05 | ND | MEDICAID | DG6885 | 01 | ND | RAILROAD MEDICARE | OTHER | 1150001 | 01 | ND | BLUE CROSS BLUE SHIELD | OTHER |