Provider Demographics
NPI:1891945796
Name:SAMPANG MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:SAMPANG MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-553-6932
Mailing Address - Street 1:56 DAISY SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4464
Mailing Address - Country:US
Mailing Address - Phone:702-242-1604
Mailing Address - Fax:
Practice Address - Street 1:56 DAISY SPRINGS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4464
Practice Address - Country:US
Practice Address - Phone:702-242-1604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty