Individual ProviderSami TammoInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831(502) 629-5552(502) 588-9490PECOS EnrollmentBased on the most recent information from CMS, provider Sami Tammo is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1720270838Provider TypeIndividualFull NameTammo, SamiCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/13/2007Last Updated11/13/2023Contact InformationPractice LocationPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831Phone(502) 629-5552Fax(502) 629-3132Mailing LocationMailing AddressPO Box 776351, Chicago, IL 60677-6351Phone(502) 588-9490Fax(502) 272-5116Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense43465KentuckyCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense2013-01852North CarolinaProvider IdentifiersIDDescriptionIssuerID182YKDescriptionOtherIssuerBCBSNorth CarolinaID9958748DescriptionOtherIssuerAETNANorth CarolinaID1720270838DescriptionOtherIssuerTRICARENorth CarolinaID272341DescriptionOtherIssuerMEDCOSTNorth CarolinaID1720270838DescriptionMedicaidIssuerUnlistedNorth CarolinaID1720270838DescriptionOtherIssuerVIRGINIA MEDICAIDVirginiaIDQ01852DescriptionOtherIssuerSOUTH CAROLINA MEDICAIDSouth CarolinaID3345588DescriptionOtherIssuerUNITED HEALTHCARENorth Carolina