Provider Demographics
NPI:1629580881
Name:MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:MEDICAL SPECIALIST
Other - Org Name:SAMSON MEDICAL SERVICES LLP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIEWCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-740-7413
Mailing Address - Street 1:102 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-3204
Mailing Address - Country:US
Mailing Address - Phone:972-740-7413
Mailing Address - Fax:469-750-7317
Practice Address - Street 1:102 ASPEN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-3204
Practice Address - Country:US
Practice Address - Phone:972-740-7413
Practice Address - Fax:469-750-7317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1265943682Medicaid