Healthcare Provider Details

I. General information

NPI: 1912257460
Provider Name (Legal Business Name): SAMARITAN PACIFIC HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 NW HWY 101 SUITE A
DEPOE BAY OR
97341-9801
US

IV. Provider business mailing address

531 NW HWY 101 SUITE A
DEPOE BAY OR
97341-9801
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5810
  • Fax: 541-768-5811
Mailing address:
  • Phone: 541-768-5810
  • Fax: 541-768-5811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIGELOW
Title or Position: CEO
Credential:
Phone: 541-574-1801