Provider Demographics
NPI:1972845485
Name:SAM MEDICAL CENTER OF AMERICA PLLC
Entity Type:Organization
Organization Name:SAM MEDICAL CENTER OF AMERICA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTWI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PHD
Authorized Official - Phone:202-223-0969
Mailing Address - Street 1:1601 18TH ST NW STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2505
Mailing Address - Country:US
Mailing Address - Phone:202-223-0969
Mailing Address - Fax:202-223-0963
Practice Address - Street 1:1601 18TH ST NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2505
Practice Address - Country:US
Practice Address - Phone:202-223-0969
Practice Address - Fax:202-223-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service