MEDICARE: SAMARITAN PACIFIC HEALTH SERVICES, 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	207RI0200X	Infectious Disease Physician

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	:	1912257460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN PACIFIC HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	531 NW HWY 101
Second Line	:	SUITE A
City	:	DEPOE BAY
State	:	OR
Zip	:	97341-9801
Country	:	US
Telephone Number	:	541-768-5810
Fax Number	:	541-768-5811

Provider Business Practice Location Address
First Line	:	531 NW HWY 101
Second Line	:	SUITE A
City	:	DEPOE BAY
State	:	OR
Zip	:	97341-9801
Country	:	US
Telephone Number	:	541-768-5810
Fax Number	:	541-768-5811

Authorized Official
Title or Position	:	CEO
Name	:	DAVID BIGELOW
Credential	:
Telephone Number	:	541-574-1801

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	06/10/2015

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