Provider Demographics
NPI:1588764476
Name:SAMSON, SCOTT H (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:SAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SOUTH CASCADE STREET
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2813
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-736-8757
Practice Address - Street 1:712 SOUTH CASCADE STREET
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2813
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-736-8757
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8D7845AOtherBCBS
MN1009175OtherPREFERREDONE
MN041019500Medicaid
ND13056Medicaid
TX1476616Medicaid
NE41091744413Medicaid
MN04-00530OtherMEDICA
MN123444OtherUCAREMN
MNHP26724OtherHEALTHPARTNERS
MN123444OtherUCAREMN
MN110113010Medicare ID - Type UnspecifiedMEDICARERAILROAD
MNHP26724OtherHEALTHPARTNERS
MN019000335Medicare ID - Type UnspecifiedMEDICARE