Provider Demographics
NPI:1255482105
Name:SAMARITAN INTERNAL MEDICINE MEDICAL GROUP
Entity Type:Organization
Organization Name:SAMARITAN INTERNAL MEDICINE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-371-6842
Mailing Address - Street 1:2410 SAMARITAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3909
Mailing Address - Country:US
Mailing Address - Phone:408-371-9010
Mailing Address - Fax:408-371-1850
Practice Address - Street 1:2410 SAMARITAN DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3909
Practice Address - Country:US
Practice Address - Phone:408-371-9010
Practice Address - Fax:408-371-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588620785OtherNPI JANE W CHIEN
CA1609832815OtherNPI JOE L MORGENSEN
CA1851357917OtherNPI CAMERON I OBA
CA1992761118OtherNPI SUNITHA GUBBALA
CAA35348Medicare UPIN
CA00A232980Medicare PIN
CA00A689750Medicare PIN
CA00A791200Medicare PIN
CAG56847Medicare UPIN
CA1609832815OtherNPI JOE L MORGENSEN
CA1992761118OtherNPI SUNITHA GUBBALA
CAH25217Medicare UPIN
CAA23467Medicare UPIN
CAH80100Medicare UPIN