Provider Demographics
NPI:1124303151
Name:SAMUEL P ROJAS MD INC
Entity type:Organization
Organization Name:SAMUEL P ROJAS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-752-4926
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0958
Mailing Address - Country:US
Mailing Address - Phone:304-752-4926
Mailing Address - Fax:304-752-4952
Practice Address - Street 1:143 1/2 STOLLINGS AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4010
Practice Address - Country:US
Practice Address - Phone:304-752-4926
Practice Address - Fax:304-752-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD49116Medicare UPIN