Provider Demographics
NPI:1477962868
Name:SAMARITAN MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:SAMARITAN MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:541-451-7107
Mailing Address - Street 1:PO BOX 1809
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1809
Mailing Address - Country:US
Mailing Address - Phone:541-768-7702
Mailing Address - Fax:541-768-9785
Practice Address - Street 1:845 SW 30TH STREET SUITE 200
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8629
Practice Address - Country:US
Practice Address - Phone:541-768-7702
Practice Address - Fax:541-768-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687343Medicaid
ORNPC-004252OtherOREGON BOARD OF PHARMACY
OR7301420001Medicare NSC