Healthcare Provider Details

I. General information

NPI: 1063669877
Provider Name (Legal Business Name): SAMS WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 LARUE ST
GARDEN CITY KS
67846-7072
US

IV. Provider business mailing address

MAIL STOP 0445 702 SW 8TH ST
BENTONVILLE AR
72716
US

V. Phone/Fax

Practice location:
  • Phone: 620-272-9001
  • Fax:
Mailing address:
  • Phone: 479-277-1242
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-10215
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2117043
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier100444790H
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: LAURA LEVINE
Title or Position: MGR OF GOVERNMENT CONTRACTING
Credential:
Phone: 479-204-8550