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NPI Code Detail

MEDICARE: SAMARITAN PACIFIC HEALTH SERVICES, INC

MEDICARE: SAMARITAN PACIFIC HEALTH SERVICES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician
2261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164781142
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMARITAN PACIFIC HEALTH SERVICES, INC
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number : 541-768-6930
Fax Number :
Provider Business Practice Location Address
First Line : 531 N HIGHWAY 101 STE A
Second Line :
City : DEPOE BAY
State : OR
Zip : 97341-9572
Country : US
Telephone Number : 541-765-3265
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. LESLEY J. OGDEN
Credential : MD, FACEP
Telephone Number : 541-557-6411
Provider Enumeration Date : 05/10/2012
Last Update Date : 05/14/2025

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Directions to “SAMARITAN PACIFIC HEALTH SERVICES, INC ” Practice Location

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