Provider Demographics
NPI:1770741597
Name:GOOD SAMARITAN HOSPITAL & HEALTH CENTER
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL & HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-278-2612
Mailing Address - Street 1:921 S. EDWIN C. MOSES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3464
Mailing Address - Country:US
Mailing Address - Phone:937-461-1376
Mailing Address - Fax:937-499-7813
Practice Address - Street 1:921 S. EDWIN C. MOSES BLVD.
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3464
Practice Address - Country:US
Practice Address - Phone:937-461-1376
Practice Address - Fax:937-499-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH361963Medicare PIN