| Shane T Sampson Md Inc | |
|
122 Martz St Greenville OH 45331-1052 | |
| (937) 459-5057 | |
| (937) 459-5285 |
| Full Name | Shane T Sampson Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 122 Martz St, Greenville, Ohio |
| Authorized Official Name and Position | Shane Timothy Sampson (PRESIDENT CEO) |
| Authorized Official Contact | 9374595057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shane T Sampson Md Inc 122 Martz St Po Box 960 Greenville OH 45331-1052 Ph: (937) 459-5057 | Shane T Sampson Md Inc 122 Martz St Greenville OH 45331-1052 Ph: (937) 459-5057 |
| NPI Number | 1598735466 |
|---|---|
| Provider Enumeration Date | 01/24/2006 |
| Last Update Date | 04/02/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598735466 | NPI | - | NPPES |
| 0891343 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35063468 (Ohio) | Primary |
| 207Q00000X | Family Medicine | 01038529 (Indiana) | Secondary |
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