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NPI Code Detail

MEDICARE: SAMS EAST INC

MEDICARE: SAMS EAST 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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail PharmacyMP0552415WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12150860OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316330624
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMS EAST INC
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line : MAILSTOP 0445
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-277-2500
Fax Number :
Provider Business Practice Location Address
First Line : 200 EMILY DR
Second Line :
City : CLARKSBURG
State : WV
Zip : 26301-5500
Country : US
Telephone Number : 304-918-6056
Fax Number :
Authorized Official
Title or Position : SENIOR DIRECTOR, ENROLLMENT
Name : KIMBERLY CANONIC
Credential :
Telephone Number : 480-853-0515
Provider Enumeration Date : 03/11/2015
Last Update Date : 06/18/2025

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Directions to “SAMS EAST INC ” Practice Location

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