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NPI Code Detail

MEDICARE: SAM'S WEST, INC.

MEDICARE: SAM'S WEST, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyPH02350NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12052275OTHERPK

General Provider Information

NPI Number : 1003092438
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAM'S WEST, INC.
Provider Business Mailing Address
First Line : MAIL STOP 0445
Second Line : 702 SW 8TH ST
City : BENTONVILLE
State : AR
Zip : 72716
Country : US
Telephone Number : 479-277-1242
Fax Number : 479-277-4331
Provider Business Practice Location Address
First Line : 7100 ARROYO CROSSING PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4057
Country : US
Telephone Number : 702-260-9003
Fax Number :
Authorized Official
Title or Position : MGR OF GOVERNMENT CONTRACTING
Name : LAURA LEVINE
Credential :
Telephone Number : 479-204-8550
Provider Enumeration Date : 01/16/2008
Last Update Date : 08/30/2023

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