Provider Demographics
NPI:1568543692
Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Other - Org Name:SAMARITAN TOLEDO CLINIC
Other - Org Type:Doing Business As
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:541-574-1814
Mailing Address - Street 1:199 WEST HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391
Mailing Address - Country:US
Mailing Address - Phone:541-574-2730
Mailing Address - Fax:541-336-7614
Practice Address - Street 1:199 WEST HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391
Practice Address - Country:US
Practice Address - Phone:541-574-2730
Practice Address - Fax:541-336-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113159Medicare PIN
381314Medicare Oscar/Certification