Healthcare Provider Details

I. General information

NPI: 1972864502
Provider Name (Legal Business Name): STEPHEN HALL SAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE N416 DOAN HALL
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE N416 DOAN HALL
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-7093
  • Fax:
Mailing address:
  • Phone: 614-366-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number128257
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301100669
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: