Provider Demographics
NPI:1295856920
Name:SAMARITAN DIALYSIS DME, LLC
Entity type:Organization
Organization Name:SAMARITAN DIALYSIS DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-768-5004
Mailing Address - Street 1:8125 W GRAND AVE
Mailing Address - Street 2:STE LL
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1206
Mailing Address - Country:US
Mailing Address - Phone:930-393-2962
Mailing Address - Fax:303-972-9077
Practice Address - Street 1:8125 W GRAND AVE
Practice Address - Street 2:STE LL
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80123-1206
Practice Address - Country:US
Practice Address - Phone:930-393-2962
Practice Address - Fax:303-972-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4193950332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5482490001Medicare NSC