MEDICARE: DR. SAMUEL C. BIELIGK M.D.

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	208600000X	Surgery Physician	K4862	TX
2	208600000X	Surgery Physician	MC-2661	ID
3	208600000X	Surgery Physician	D57659	MD
4	261QM1300X	Multi-Specialty Clinic/Center	K4862	TX
5	2086X0206X	Surgical Oncology Physician	2008010215	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00785793	OTHER	MO	RAIL ROAD MEDICARE

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	MC-2661	OTHER	ID	IDAHO LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982618112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL C. BIELIGK M.D.

Provider Business Mailing Address
First Line	:	415 6TH STREET
Second Line	:	ATTN: PHYSICIAN SERVICES
City	:	LEWISTON
State	:	ID
Zip	:	83501-2434
Country	:	US
Telephone Number	:	208-750-7462
Fax Number	:	208-750-7467

Provider Business Practice Location Address
First Line	:	415 6TH ST
Second Line	:
City	:	LEWISTON
State	:	ID
Zip	:	83501
Country	:	US
Telephone Number	:	208-743-7612
Fax Number	:	208-746-4802

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/20/2026

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