Provider Demographics
NPI:1093370264
Name:SAMARITAN HEALTH CARE, PC
Entity Type:Organization
Organization Name:SAMARITAN HEALTH CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-260-1632
Mailing Address - Street 1:811 E KENT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9791
Mailing Address - Country:US
Mailing Address - Phone:616-225-0202
Mailing Address - Fax:616-225-0207
Practice Address - Street 1:4361 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8594
Practice Address - Country:US
Practice Address - Phone:616-225-0202
Practice Address - Fax:616-225-0207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health