Provider Demographics
NPI:1083953103
Name:OSAMA AL-SAMKARI M.D. INC
Entity type:Organization
Organization Name:OSAMA AL-SAMKARI M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SAMKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-258-1467
Mailing Address - Street 1:1121 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2851
Mailing Address - Country:US
Mailing Address - Phone:937-258-1467
Mailing Address - Fax:937-258-0236
Practice Address - Street 1:1121 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2851
Practice Address - Country:US
Practice Address - Phone:937-258-1467
Practice Address - Fax:937-258-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3540644261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404735Medicaid
OHAL0467913Medicare Oscar/Certification
OH0404735Medicaid