=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518103753
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMMARIAN MEDICAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2008
-----------------------------------------------------
Last Update Date | 01/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7035 N CHESTNUT AVE STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-324-0700
-----------------------------------------------------
Fax | 559-324-0701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7035 N CHESTNUT AVE STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-0352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-324-0700
-----------------------------------------------------
Fax | 559-324-0701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. O'KEY SAMS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-324-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A55586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------