Provider Demographics
NPI:1134457955
Name:GOOD SAMARITAN REGIONAL HEALTH CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN REGIONAL HEALTH CENTER
Other - Org Name:GOOD SAMARITAN HOSPITALIST PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVISCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-899-1040
Mailing Address - Street 1:211 S LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3655
Mailing Address - Country:US
Mailing Address - Phone:618-436-6057
Mailing Address - Fax:618-532-9365
Practice Address - Street 1:1 GOOD SAMARITAN WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2402
Practice Address - Country:US
Practice Address - Phone:618-899-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN REGIONAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-07
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty