MEDICARE: SAMANTHA CUMMINS BS

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346198454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA CUMMINS BS

Provider Business Mailing Address
First Line	:	902 W MAIN ST
Second Line	:
City	:	WEST FRANKFORT
State	:	IL
Zip	:	62896-2210
Country	:	US
Telephone Number	:	618-326-2772
Fax Number	:	618-937-1440

Provider Business Practice Location Address
First Line	:	1307 W MAIN ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-1139
Country	:	US
Telephone Number	:	618-997-5336
Fax Number	:	618-993-2969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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