MEDICARE: SAMARITAN MEDICAL CENTER

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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1447051305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1308 WASHINGTON ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4532
Country	:	US
Telephone Number	:
Fax Number	:	888-391-0053

Provider Business Practice Location Address
First Line	:	1308 WASHINGTON ST
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-4532
Country	:	US
Telephone Number	:	812-954-6751
Fax Number	:	812-291-9612

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS HAROLD CARMAN
Credential	:
Telephone Number	:	315-785-4121

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	04/23/2025

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Directions to “SAMARITAN MEDICAL CENTER ” Practice Location

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