Provider Demographics
NPI:1346652286
Name:SAM MEDICAL CENTER OF AMERICA PLLC
Entity Type:Organization
Organization Name:SAM MEDICAL CENTER OF AMERICA PLLC
Other - Org Name:SAM MEDICAL HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PHD(C)
Authorized Official - Phone:202-223-0969
Mailing Address - Street 1:2141 K ST NW STE 607
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1810
Mailing Address - Country:US
Mailing Address - Phone:202-223-0969
Mailing Address - Fax:202-223-0963
Practice Address - Street 1:2141 K ST NW STE 607
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1810
Practice Address - Country:US
Practice Address - Phone:202-223-0969
Practice Address - Fax:202-223-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health