MEDICARE: GOOD SAMARITAN REGIONAL HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273Y00000X	Rehabilitation Hospital Unit	0004705	IL

General Provider Information

NPI Number	:	1043270424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN REGIONAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 503927
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-0001
Country	:	US
Telephone Number	:	618-242-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GOOD SAMARITAN WAY
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2402
Country	:	US
Telephone Number	:	618-242-4600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEREMY BRADFORD
Credential	:
Telephone Number	:	618-899-1001

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	11/27/2023

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