Provider Demographics
NPI:1407845035
Name:GOOD SAMARITAN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN MEDICAL CENTER, LLC
Other - Org Name:GOOD SAMARITAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-689-5210
Mailing Address - Street 1:200 EXEMPLA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3370
Mailing Address - Country:US
Mailing Address - Phone:303-689-4000
Mailing Address - Fax:
Practice Address - Street 1:200 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-689-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0570282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO060116Medicare Oscar/Certification