Healthcare Provider Details

I. General information

NPI: 1427504109
Provider Name (Legal Business Name): SAMANTHA BROWN DME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 W US HIGHWAY 50
FAIRVIEW HEIGHTS IL
62208-2927
US

IV. Provider business mailing address

1923 W US HIGHWAY 50
FAIRVIEW HEIGHTS IL
62208-2927
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-9499
  • Fax:
Mailing address:
  • Phone: 618-628-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number012008420
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number011253854
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: