Provider Demographics
NPI:1669757555
Name:OMBAT, SAMSTEVE B
Entity type:Individual
Prefix:MR
First Name:SAMSTEVE
Middle Name:B
Last Name:OMBAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E MISHAWAKA RD LOT 13
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-2394
Mailing Address - Country:US
Mailing Address - Phone:574-322-8520
Mailing Address - Fax:
Practice Address - Street 1:855 E MISHAWAKA RD LOT 13
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2394
Practice Address - Country:US
Practice Address - Phone:574-322-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment