Healthcare Provider Details

I. General information

NPI: 1083552699
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

75 PUBLIC SQ APT 906
CLEVELAND OH
44113-2006
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-1800
  • Fax: 513-751-8638
Mailing address:
  • Phone: 216-466-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. KHODOR OTHMAN CHABAKLO
Title or Position: RESIDENT PHYSICIAN
Credential: MD
Phone: 216-466-6491