MEDICARE: SAMSON JAGGER CONSTRUCTION, LLC

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	171WH0202X	Home Modifications Contractor	2210563	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891186714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMSON JAGGER CONSTRUCTION, LLC

Provider Business Mailing Address
First Line	:	7565 BROADVIEW RD STE 1
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-5751
Country	:	US
Telephone Number	:	330-467-2227
Fax Number	:	216-264-8017

Provider Business Practice Location Address
First Line	:	7565 BROADVIEW RD STE 1
Second Line	:
City	:	SEVEN HILLS
State	:	OH
Zip	:	44131-5751
Country	:	US
Telephone Number	:	330-467-2227
Fax Number	:	216-264-8017

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT P CARAVONA
Credential	:
Telephone Number	:	330-467-2227

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	07/25/2025

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