Healthcare Provider Details

I. General information

NPI: 1134457955
Provider Name (Legal Business Name): GOOD SAMARITAN REGIONAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 01/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2402
US

IV. Provider business mailing address

211 S LINCOLN BLVD
CENTRALIA IL
62801-3655
US

V. Phone/Fax

Practice location:
  • Phone: 618-899-4600
  • Fax:
Mailing address:
  • Phone: 618-436-6057
  • Fax: 618-532-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. DEE EVISCHI
Title or Position: VP FINANCIAL SERVICES
Credential:
Phone: 618-899-1040