SAMS WEST INC SOS Verified
4835 KIETZKE LN, RENO, NV 89509
NPI Number
1063439172
Practice location · View on Google Maps
SOS Verification: Verified
Entity Name: SAM'S WEST, INC.
Entity Number: C10085-2000
Entity Type: Foreign Corporation
Entity Status: Active
Formation Date: 2000-04-11
Status Changed: 2010-06-22
Name Match: 95%
Registered Agent
Name: C T CORPORATION SYSTEM**
Type: Commercial Registered Agent
Address: 701 S CARSON ST STE 200, Carson City, NV, 89701
Officers / Principals
| Title | Name | Address | Status |
|---|---|---|---|
| President | Chris Nicholas | 1 Customer Dr, Bentonville, AR | Active |
| Director | Chris Nicholas | 1 Customer Dr, Bentonville, AR | Active |
| Secretary | Geoffrey Edwards | 1 Customer Dr, Bentonville, AR | Active |
| Secretary | Harley Jarvis | 1 Customer Dr,, Bentonville, AR | Active |
| Treasurer | Matthew Allen | 1 Customer Dr, Bentonville, AR | Active |
Campaign Contributions
$1,100Total Contributed
1Candidates Supported
Officer / Individual Matches
Chris NicholasProbable Match
Matched via officer: Chris Nicholas (President)
$550 across 1 contribution
| Candidate | Office | Party | Total | Count |
|---|---|---|---|---|
| Nevada Hospital Association HealthPAC | PAC | $550 | 1 |
Chris NicholasProbable Match
Matched via officer: Chris Nicholas (President)
$550 across 1 contribution
| Candidate | Office | Party | Total | Count |
|---|---|---|---|---|
| Nevada Hospital Association HealthPAC | PAC | $550 | 1 |
Data Notice Campaign contribution matches are based on automated name matching against Nevada Secretary of State campaign finance records. Corporate matches compare registered business names. Officer matches compare individual names and may include false positives due to common names. Contributions are to Nevada state and local candidates only.
Payments by Year
How much Medicaid paid this provider each year. Large jumps can indicate changes in practice volume or billing patterns.
| Year | Total Paid | % of Max |
|---|---|---|
| 2021 | $0 |
Procedure Code Breakdown
The specific medical services this provider billed Medicaid for. Each HCPCS/CPT code represents a different type of visit, test, or treatment.
| HCPCS Code | Description | Claims | Paid | % of Total | Avg per Claim |
|---|---|---|---|---|---|
| 0011A | Medical service or procedure | 34 | $0 | 0.0% | $0 |
| 0012A | Medical service or procedure | 20 | $0 | 0.0% | $0 |