Healthcare Provider Details

I. General information

NPI: 1801902713
Provider Name (Legal Business Name): SAMARITAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

IV. Provider business mailing address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-4955
  • Fax:
Mailing address:
  • Phone: 315-786-4955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number2201000H
License Number StateNY

VIII. Authorized Official

Name: MS. CHRIS HOCHGRAF
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 315-779-5278