Healthcare Provider Details

I. General information

NPI: 1407845035
Provider Name (Legal Business Name): GOOD SAMARITAN MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone: 303-689-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0570
License Number StateCO

VIII. Authorized Official

Name: HILDA DALFONSO
Title or Position: VP FINANCE
Credential:
Phone: 303-689-5210