Provider Demographics
NPI:1871859017
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:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-768-5001
Mailing Address - Street 1:3640 NW SAMARITAN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3738
Mailing Address - Country:US
Mailing Address - Phone:541-768-5300
Mailing Address - Fax:
Practice Address - Street 1:3640 NW SAMARITAN DR STE 220
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3784
Practice Address - Country:US
Practice Address - Phone:541-768-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651472Medicaid
OR500651472Medicaid