BRADLEY E. SAMUELSON, MD PA NPI 1003002262

Internal Medicine (Cardiovascular Disease) in Wichita Falls, TX

Organization Internal Medicine Cardiovascular Disease

About BRADLEY E. SAMUELSON, MD PA

Bradley E. Samuelson, Md Pa is a provider established in Wichita Falls, Texas specializing in internal medicine. The NPI number of Bradley E. Samuelson, Md Pa is 1003002262 and was assigned on September 2007. The practitioner's primary taxonomy code is 207RC0000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. Bradley E. Samuelson, Md Pa operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Lili Samuelson (Manager)

NPI

1003002262

Provider NameBRADLEY E. SAMUELSON, MD PA
Provider Location Address1004 BROOK AVE WICHITA FALLS, TX 76301
Provider Mailing Address1004 BROOK AVE WICHITA FALLS, TX 76301
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date09-21-2007
Last Update Date02-19-2008

Primary Taxonomy

Taxonomy Code207RC0000X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationCardiovascular Disease
Taxonomy DescriptionAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

Business Address

BRADLEY E. SAMUELSON, MD PA
1004 BROOK AVE
WICHITA FALLS, TX
ZIP 76301
Phone: (940) 687-7100
Fax: (940) 687-7104

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Mailing Address

BRADLEY E. SAMUELSON, MD PA
1004 BROOK AVE
WICHITA FALLS, TX
ZIP 76301
Phone: (940) 687-7100
Fax: (940) 687-7104

Authorized Official

Authorized Official Name LILI SAMUELSON
Authorized Official TitleMANAGER
Authorized Official Phone(940) 687-7100

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
00555YMEDICARE PIN (08)TX

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1528000841DR. SANDRA VERGARA DDS, PA
Individual
Dentist (Oral and Maxillofacial Surgery)1004 BROOK AVE
WICHITA FALLS, TX 76301
(940) 264-6000
1912015165DR. BRADLEY E SAMUELSON M.D
Individual
Internal Medicine (Cardiovascular Disease)1004 BROOK AVE
WICHITA FALLS, TX 76301
(940) 687-7100

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.