Provider Demographics
NPI:1609868413
Name:GOOD SAMARITAN HOSPITAL
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RN,CHCE,CDHP
Authorized Official - Phone:253-301-6400
Mailing Address - Street 1:PO BOX 5200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0200
Mailing Address - Country:US
Mailing Address - Phone:253-301-6400
Mailing Address - Fax:253-301-6528
Practice Address - Street 1:3901 S FIFE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7309
Practice Address - Country:US
Practice Address - Phone:253-301-6400
Practice Address - Fax:253-301-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS302251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGO1222OtherREGENCE HOME HEALTH
WA9007618Medicaid
WA0439370003OtherCIGNA MEDICARE
WAWA2923OtherMOLINA
WA9166505Medicaid
WA0004OtherCHAMPUS HOME HEALTH
WA1258OtherPREMERA
WA1258OtherPREMERA