Provider Demographics
NPI:1942357355
Name:SAMARITAN PACIFIC HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES INC
Other - Org Name:SAMARITAN DEPOE BAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-557-6411
Mailing Address - Street 1:531 N HIGHWAY 101 STE A
Mailing Address - Street 2:
Mailing Address - City:DEPOE BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97341-9572
Mailing Address - Country:US
Mailing Address - Phone:541-765-3265
Mailing Address - Fax:541-765-3260
Practice Address - Street 1:531 N HIGHWAY 101 STE A
Practice Address - Street 2:
Practice Address - City:DEPOE BAY
Practice Address - State:OR
Practice Address - Zip Code:97341-9572
Practice Address - Country:US
Practice Address - Phone:541-765-3265
Practice Address - Fax:541-765-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286726Medicaid
381314Medicare Oscar/Certification
R111876Medicare PIN