MEDICARE: MR. CHARLES M SAMP PA-C

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	363A00000X	Physician Assistant	1554	AZ

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	:	1538126545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES M SAMP PA-C

Provider Business Mailing Address
First Line	:	6242 E ARBOR AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-1309
Country	:	US
Telephone Number	:	480-610-8183
Fax Number	:	480-089-5311

Provider Business Practice Location Address
First Line	:	6242 E ARBOR AVE
Second Line	:	STE 111
City	:	MESA
State	:	AZ
Zip	:	85206-1309
Country	:	US
Telephone Number	:	480-610-8183
Fax Number	:	480-895-3110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. CHARLES M SAMP PA-C” Practice Location

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