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NPI Code Detail

MEDICARE: MR. SAM JENKINS

MEDICARE: MR. SAM JENKINS
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
1247200000XOther Technician274531

General Provider Information

NPI Number : 1508042227
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SAM JENKINS
Provider Business Mailing Address
First Line : 1306 ADAMS AVE
Second Line :
City : LA GRANDE
State : OR
Zip : 97850-2610
Country : US
Telephone Number : 541-786-4763
Fax Number :
Provider Business Practice Location Address
First Line : 1306 ADAMS AVE
Second Line :
City : LA GRANDE
State : OR
Zip : 97850-2610
Country : US
Telephone Number : 541-786-4763
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2008
Last Update Date : 01/11/2008

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