Provider Demographics
NPI:1770515991
Name:GOOD SAMARITAN MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:GOOD SAMARITAN MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GUITTAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-671-7171
Mailing Address - Street 1:PO BOX 741182
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1182
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:561-650-6127
Practice Address - Street 1:1309 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3406
Practice Address - Country:US
Practice Address - Phone:561-655-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4070282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
131OtherBCBS OF FLORIDA
621124806OtherTRICARE
FL010152400Medicaid
100287B000000OtherSECTION 1011
119588OtherCOVENTRY HEALTH CARE GROU
72-2932824OtherPACIFICARE
990103OtherNEIGHBORHOOD HEALTH PLAN
023240390OtherAETNA US HEALTHCARE (NATI
080098OtherHUMANA
FL010152400Medicaid