Provider Demographics
NPI:1447352737
Name:SAMARITAN ENDOSCOPY CENTER, INC.
Entity type:Organization
Organization Name:SAMARITAN ENDOSCOPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAFFOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-0988
Mailing Address - Street 1:15195 NATIONAL AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2631
Mailing Address - Country:US
Mailing Address - Phone:408-356-0988
Mailing Address - Fax:408-356-0978
Practice Address - Street 1:15195 NATIONAL AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2631
Practice Address - Country:US
Practice Address - Phone:408-356-0988
Practice Address - Fax:408-356-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000093261Q00000X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54220ZZH4328ZOtherBLUE SHIELD
CAA51744Medicaid
CA550000093OtherLICENSE
CAA51744Medicaid
CAZZZ318727Medicare ID - Type Unspecified