Provider Demographics
NPI:1790041549
Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Other - Org Name:SAMARITAN OCCUPATIONAL MEDICINE - CORVALLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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 1:5234 SW PHILOMATH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1042
Mailing Address - Country:US
Mailing Address - Phone:541-768-6211
Mailing Address - Fax:
Practice Address - Street 1:5234 PHILOMATH BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3767
Practice Address - Country:US
Practice Address - Phone:541-768-6211
Practice Address - Fax:541-768-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651540Medicaid