Provider Demographics
NPI:1164781142
Name:SAMARITAN PACIFIC HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES, INC
Other - Org Name:SAMARITAN KIDNEY SPECIALISTS - NEWPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACEP
Authorized Official - Phone:541-557-6411
Mailing Address - Street 1:775 SW 9TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4850
Mailing Address - Country:US
Mailing Address - Phone:541-768-6930
Mailing Address - Fax:
Practice Address - Street 1:930 SW ABBEY ST STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4820
Practice Address - Country:US
Practice Address - Phone:541-574-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500652456Medicaid