Provider Demographics
NPI:1386814598
Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-451-6364
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-0459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2852
Practice Address - Country:US
Practice Address - Phone:541-451-6364
Practice Address - Fax:541-451-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500614663Medicaid
ORNPC-0003036OtherOREGON BOARD OF PHARMACY
ORNPC-0003036OtherOREGON BOARD OF PHARMACY