MEDICARE: SAMS WEST INC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	054016510	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1482431	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1881841690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS WEST INC

Provider Business Mailing Address
First Line	:	702 SW 8TH ST
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-6209
Country	:	US
Telephone Number	:	479-277-1238
Fax Number	:	479-277-4331

Provider Business Practice Location Address
First Line	:	700 N 54TH ST
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-7909
Country	:	US
Telephone Number	:	217-222-6682
Fax Number	:

Authorized Official
Title or Position	:	MGR OF GOVERNMENT CONTRACTING
Name	:	LAURA LEVINE
Credential	:
Telephone Number	:	479-204-8550

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	08/23/2023

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Directions to “SAMS WEST INC ” Practice Location

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