1447352737 NPI number — SAMARITAN ENDOSCOPY CENTER, INC.

Table of content: (NPI 1447352737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447352737 NPI number — SAMARITAN ENDOSCOPY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAN ENDOSCOPY CENTER, INC.
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:
Provider Other Organization Name Type Code:
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:
1447352737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15195 NATIONAL AVENUE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-356-0988
Provider Business Mailing Address Fax Number:
408-356-0978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15195 NATIONAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95032-2631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-356-0988
Provider Business Practice Location Address Fax Number:
408-356-0978
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAFFOURI
Authorized Official First Name:
BASSAM
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
408-356-0988

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  550000093 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0800X , with the licence number: 550000093 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54220ZZH4328Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A51744 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 550000093 . This is a "LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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