MEDICARE: MISS SAMANTHA STEINIS P.A.

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	363AS0400X	Surgical Physician Assistant	085004946	IL
2	363A00000X	Physician Assistant	PA09703	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01878823	OTHER	TX	MEDICARE RAIL ROAD
7	P01878870	OTHER	TX	MEDICARE RAIL ROAD
9	587304YMAF	OTHER	TX	MEDICARE
10	587304YNSX	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75-2616977-001	OTHER	TX	TRICARE
2	75-2616977-002	OTHER	TX	TRICARE
3	75-2616977-028	OTHER	TX	TRICARE
4	75-2616977-129	OTHER	TX	TRICARE
6	75-0818167-022	OTHER	TX	TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	75-2616977-007	OTHER	TX	TRICARE
13	8GY028	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1699197699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SAMANTHA STEINIS P.A.

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284
Country	:	US
Telephone Number	:	903-324-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 S BROADWAY ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-4895
Country	:	US
Telephone Number	:	903-951-1000
Fax Number	:

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	11/10/2017

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Directions to “ MISS SAMANTHA STEINIS P.A.” Practice Location

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