Healthcare Provider Details

I. General information

NPI: 1306285630
Provider Name (Legal Business Name): SAMUEL S. ADAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL PL STE 104
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

3765 E. BLUE LUPINE DR. SUITE D
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-5770
  • Fax: 888-385-3430
Mailing address:
  • Phone: 907-707-1671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number256520
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number147744
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number28244
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number147744
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: