MEDICARE: SAMSON K ORUSA PC

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	261QP3300X	Pain Clinic/Center	28275	TN
2	261QP2300X	Primary Care Clinic/Center	28275	TN

General Provider Information

NPI Number	:	1770715013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMSON K ORUSA PC

Provider Business Mailing Address
First Line	:	261 STONECROSSING DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-8404
Country	:	US
Telephone Number	:	931-906-4366
Fax Number	:	931-906-4365

Provider Business Practice Location Address
First Line	:	261 STONECROSSING DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-8404
Country	:	US
Telephone Number	:	931-906-4366
Fax Number	:	931-906-4365

Authorized Official
Title or Position	:	PRESIDENT.
Name	:	DR. SAMSON KANLA ORUSA
Credential	:	M.D
Telephone Number	:	931-906-4366

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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