NPIMap

Organization Active NPI

Samuel H. Davis MD PA

  • Pediatrics Physician
  • Saginaw, TX
National Provider Identifier
1396010096
Registry record updated Aug 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M7134 Issued in TX
Legal business name
SAMUEL H. DAVIS MD PA
Practice address
604 E. Bailey Boswell
Suite 140
Saginaw, TX 76131
Phone
(817) 484-6610
Fax
(817) 423-7476
NPI assigned
Mar 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Dean A. Delawter, MHA
Title
Ceo/Senior Partner-on-Site-Medical
Phone
(940) 484-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X M7134 TX Primary

Addresses

Primary practice location

604 E. Bailey Boswell
Suite 140
Saginaw, TX 76131

Mailing address

3205 Medpark Drive
Denton, TX 76208-6932
Phone (940) 484-6500

Other identifiers 1

IdentifierTypeStateIssuer
1396010096OtherTXTRICARE

Other names 1

  • Child Plus Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2040088Child Plus Pediatrics604 E Bailey Boswell Road Suite 140, Saginaw, TX 76131Certificate of waiverApr 22, 2028

National Provider Directory

National Provider Directory

Locations

3205 Medpark Dr
Denton, TX 76208
Phone (940) 382-8400

604 E Bailey Boswell Rd
Ste 140
Saginaw, TX 76131
Phone (817) 484-6610

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1396010096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 MEDPARK DRIVE",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762086932",
            "telephone_number": "940-484-6500",
            "fax_number": "800-481-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 E. BAILEY BOSWELL",
            "address_2": "SUITE 140",
            "city": "SAGINAW",
            "state": "TX",
            "postal_code": "76131",
            "telephone_number": "817-484-6610",
            "fax_number": "817-423-7476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL H. DAVIS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "DELAWTER",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO/SENIOR PARTNER-ON-SITE-MEDICAL",
        "authorized_official_telephone_number": "940-484-6500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "M7134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1396010096",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Child Plus Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saginaw, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.