Provider Demographics
NPI:1912257460
Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-574-1801
Mailing Address - Street 1:531 NW HWY 101
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-9801
Mailing Address - Country:US
Mailing Address - Phone:541-768-5810
Mailing Address - Fax:541-768-5811
Practice Address - Street 1:531 NW HWY 101
Practice Address - Street 2:SUITE A
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-9801
Practice Address - Country:US
Practice Address - Phone:541-768-5810
Practice Address - Fax:541-768-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657708Medicaid
OR500657708Medicaid