Provider Demographics
NPI:1407257280
Name:SAMARITAN HEALTH CLINIC OF PICKENS COUNTY
Entity Type:Organization
Organization Name:SAMARITAN HEALTH CLINIC OF PICKENS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-855-0853
Mailing Address - Street 1:303 DACUSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1510
Mailing Address - Country:US
Mailing Address - Phone:864-855-0853
Mailing Address - Fax:864-855-5882
Practice Address - Street 1:303 DACUSVILLE HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1510
Practice Address - Country:US
Practice Address - Phone:864-855-0853
Practice Address - Fax:864-855-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center