=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568543692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMARITAN PACIFIC HEALTH SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 WEST HIGHWAY 20
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-574-2730
-----------------------------------------------------
Fax | 541-336-7614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 199 W HIGHWAY 20
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97391-1242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-574-2730
-----------------------------------------------------
Fax | 541-336-7614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LESLEY OGDEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-574-1814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------