Provider Demographics
NPI:1700934338
Name:SAMARITAN NORTH LINCOLN HOSPITAL
Entity Type:Organization
Organization Name:SAMARITAN NORTH LINCOLN HOSPITAL
Other - Org Name:SAMARITAN SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-996-7100
Mailing Address - Street 1:3100 NE 28TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4524
Mailing Address - Country:US
Mailing Address - Phone:541-994-8114
Mailing Address - Fax:541-994-9769
Practice Address - Street 1:3100 NE 28TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4524
Practice Address - Country:US
Practice Address - Phone:541-994-8114
Practice Address - Fax:541-994-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
115350Medicare ID - Type Unspecified