Healthcare Provider Details

I. General information

NPI: 1457916637
Provider Name (Legal Business Name): SAMARITAN HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 US HIGHWAY 31 S
CHARLEVOIX MI
49720-9703
US

IV. Provider business mailing address

811 E KENT RD
GREENVILLE MI
48838-9791
US

V. Phone/Fax

Practice location:
  • Phone: 616-225-0202
  • Fax: 616-225-0207
Mailing address:
  • Phone: 616-225-0202
  • Fax: 616-225-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK D CLARK
Title or Position: PRESIDENT
Credential: MD
Phone: 231-260-1632