Provider Demographics
NPI:1447516687
Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL CORVALLIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-768-5009
Mailing Address - Street 1:777 NW 9TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6169
Mailing Address - Country:US
Mailing Address - Phone:541-768-4900
Mailing Address - Fax:541-768-4901
Practice Address - Street 1:330 NW ELKS DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3779
Practice Address - Country:US
Practice Address - Phone:541-768-4900
Practice Address - Fax:541-639-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651482Medicaid
OR500651482Medicaid