Provider Demographics
NPI:1457402232
Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SAMARITAN PACIFIC HEALTH SERVICES, INC.
Other - Org Name:SAMARITAN MEDICAL SUPPLIES- NEWPORT
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:MD
Authorized Official - Phone:541-574-1801
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-0459
Mailing Address - Country:US
Mailing Address - Phone:541-574-7200
Mailing Address - Fax:
Practice Address - Street 1:705 SW COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5017
Practice Address - Country:US
Practice Address - Phone:541-574-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-9121332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500615038Medicaid
ORNPC-0001885OtherOREGON BOARD OF PHARMACY
ORNPC-0001885OtherOREGON BOARD OF PHARMACY