Provider Demographics
NPI:1205192457
Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Other - Org Name:SAMARITAN PLASTIC,RECONSTRUCTIVE & HAND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-768-5009
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:541-768-6768
Mailing Address - Fax:541-768-9771
Practice Address - Street 1:996 NW CIRCLE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1485
Practice Address - Country:US
Practice Address - Phone:541-768-4370
Practice Address - Fax:541-768-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14-1074208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651831Medicaid