Provider Demographics
NPI:1518103753
Name:SAMMARIAN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SAMMARIAN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:O'KEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-324-0700
Mailing Address - Street 1:7035 N CHESTNUT AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0352
Mailing Address - Country:US
Mailing Address - Phone:559-324-0700
Mailing Address - Fax:559-324-0701
Practice Address - Street 1:7035 N CHESTNUT AVE
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0352
Practice Address - Country:US
Practice Address - Phone:559-324-0700
Practice Address - Fax:559-324-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty