Provider Demographics
NPI:1578721957
Name:ROBERT L SAMS
Entity Type:Organization
Organization Name:ROBERT L SAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMERIST
Authorized Official - Phone:423-543-3421
Mailing Address - Street 1:114 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3339
Mailing Address - Country:US
Mailing Address - Phone:423-543-3421
Mailing Address - Fax:423-543-7099
Practice Address - Street 1:114 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3339
Practice Address - Country:US
Practice Address - Phone:423-543-3421
Practice Address - Fax:423-543-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNO361332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03518029Medicaid
03518029Medicare PIN
UO1202Medicare UPIN
0341720001Medicare NSC