MEDICARE: SAMARITAN PACIFIC HEALTH SERVICES 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
1	207Y00000X	Otolaryngology Physician	141460	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447308416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN PACIFIC HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	904 SW BAY STREET
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4860
Country	:	US
Telephone Number	:	541-574-4677
Fax Number	:	541-574-4663

Provider Business Practice Location Address
First Line	:	904 SW BAY STREET
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4860
Country	:	US
Telephone Number	:	541-574-4677
Fax Number	:	541-574-4663

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID C. BIGELOW
Credential	:
Telephone Number	:	541-574-1801

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/27/2008

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