Provider Demographics
NPI:1376164129
Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Other - Org Name:SAMARITAN MEDICAL GROUP - BREAST CENTER - CORVALLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO-GSRMC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ALFERD
Authorized Official - Last Name:HENNUM
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:541-768-4410
Mailing Address - Fax:
Practice Address - Street 1:501 NW ELKS DR STE 101
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3757
Practice Address - Country:US
Practice Address - Phone:541-768-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL CORVALLIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-04
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center