Provider Demographics
NPI:1407879448
Name:GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL
Other - Org Name:GOOD SAMARITAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO - CHI HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:10 E 31ST ST
Mailing Address - Street 2:P.O. BOX 1990
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2926
Mailing Address - Country:US
Mailing Address - Phone:308-865-7900
Mailing Address - Fax:308-865-2913
Practice Address - Street 1:2501 30TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4017
Practice Address - Country:US
Practice Address - Phone:308-865-7900
Practice Address - Fax:308-865-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE071002251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
299OtherBLUE CROSS
299OtherBLUE CROSS
NE=========01Medicaid
NE28-1501Medicare ID - Type Unspecified