Provider Demographics
NPI:1699197699
Name:STEINIS, SAMANTHA (PA)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:STEINIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1339 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4895
Practice Address - Country:US
Practice Address - Phone:903-951-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004946363AS0400X
TXPA09703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-2616977-028OtherTRICARE
TX75-2616977-129OtherTRICARE
TXP01878823OtherMEDICARE RAIL ROAD
TX75-0818167-022OtherTRICARE
TXP01878870OtherMEDICARE RAIL ROAD
TX374300702Medicaid
TX587304YMAFOtherMEDICARE
TX587304YNSXOtherMEDICARE
TX374300701Medicaid
TX75-2616977-007OtherTRICARE
TX8GY028OtherBCBS
TX8GY028OtherBCBS