Provider Demographics
NPI:1447308416
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:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-574-1801
Mailing Address - Street 1:904 SW BAY STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4860
Mailing Address - Country:US
Mailing Address - Phone:541-574-4677
Mailing Address - Fax:541-574-4663
Practice Address - Street 1:904 SW BAY STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4860
Practice Address - Country:US
Practice Address - Phone:541-574-4677
Practice Address - Fax:541-574-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR141460207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287004Medicaid
R131127Medicare PIN
381314Medicare Oscar/Certification