1245599224 NPI number — SAMARITAN NORTH LINCOLN HOSPITAL

Table of content: (NPI 1245599224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245599224 NPI number — SAMARITAN NORTH LINCOLN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAN NORTH LINCOLN HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAMARITAN KIDNEY SPECIALISTS - LINCOLN CITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245599224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 NE 28TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LINCOLN CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97367-4524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-768-6930
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 NE 28TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLN CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-768-6930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OGDEN
Authorized Official First Name:
LESLEY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
541-996-7100

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500652915 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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