Provider Demographics
NPI:1215121843
Name:SNYDER, SAMANTHA J (CSA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MCCOY AVENUE
Mailing Address - Street 2:SUITE 442
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2963
Mailing Address - Country:US
Mailing Address - Phone:270-824-6655
Mailing Address - Fax:270-824-6629
Practice Address - Street 1:44 MCCOY AVE
Practice Address - Street 2:SUITE 442
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2963
Practice Address - Country:US
Practice Address - Phone:270-824-6655
Practice Address - Fax:270-824-6629
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA162246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000430705OtherANTHEM PIN #
3032OtherNATIONAL SURGICAL ASSIST ASSOC #
KYSA162OtherSURGICAL ASSIST KY BD OF MED LIC #