Samuel M. Allen II, M.D.
Individual provider Active NPI Family Medicine Physician · Quitman, MS
NPI 1003898412 · NPPES record last updated Nov 6, 2013
Key facts
- NPI
- 1003898412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 06374 (MS)
- Practice address
- 603 S Archusa Ave
Quitman, MS 39355-2331 - Phone
- (601) 776-2123
- Fax
- (601) 776-6006
- NPI assigned
- Nov 20, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasawhay Emergency Physicians LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 06374 | MS | Yes |
Addresses
Primary practice location
603 S Archusa Ave
Quitman, MS 39355-2331
Mailing address
PO Box 5208
Meridian, MS 39302-5208
Phone (601) 703-4282
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010065827 | Other | RAILROAD MEDICARE | |
| 730-07862 | Other | BLUE CROSS OF AL | |
| 00014132 | Medicaid | MS |
Other providers in Quitman, MS
- Amedisys Mississippi, L.L.C.
- Archusa Family Dentistry
- Sara A. Askew
- Robin Melissa Aucoin
- Patrick Barber
All providers in Quitman, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.