MEDICARE: SAMS EAST 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	20576	TX

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
2	2094701	OTHER		PK

General Provider Information

NPI Number	:	1588681613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS EAST INC

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:	479-277-1242
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	12000 MCCREE RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-3275
Country	:	US
Telephone Number	:	214-461-8777
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/17/2025

Similar Medicare Providers

1255302477 — DR. DIANA THI NGUYEN O.D.
Practice Location Address:

12000 MCCREE RD
DALLAS, TX
75238-3275

Practice Phone: 214-341-0422
Practice Fax: 241-341-0422

1932281136 — SAM'S CLUB OPTICAL
Practice Location Address:

12000 MCCREE RD
DALLAS, TX
75238-3275

Practice Phone: 214-342-9810
Practice Fax:

1811597040 — THAO N KHAMNOUANE PHARMD
Practice Location Address:

12000 MCCREE RD
DALLAS, TX
75238-3275

Practice Phone: 214-461-8777
Practice Fax:

1194691634 — 20-20 VISION CENTER
Practice Location Address:

12000 MCCREE RD
DALLAS, TX
75238-3275

Practice Phone: 214-727-6522
Practice Fax:

1346445426 — JASON PATRICK VAUGHN DC
Practice Location Address:

3754 HIRAM ACWORTH HWY STE A
DALLAS, GA
30157-3275

Practice Phone: 770-443-0090
Practice Fax:

1588025944 — VAUGHN CHIROPRACTIC LLC
Practice Location Address:

3754 HIRAM ACWORTH HWY , SUITE A
DALLAS, GA
30157-3275

Practice Phone: 770-443-0090
Practice Fax: 770-443-0070

Directions to “SAMS EAST INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.