Healthcare Provider Details

I. General information

NPI: 1164781142
Provider Name (Legal Business Name): SAMARITAN PACIFIC HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N HIGHWAY 101 STE A
DEPOE BAY OR
97341-9572
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-765-3265
  • Fax:
Mailing address:
  • Phone: 541-768-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLEY J. OGDEN
Title or Position: CEO
Credential: MD, FACEP
Phone: 541-557-6411