Healthcare Provider Details

I. General information

NPI: 1770741597
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL & HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S. EDWIN C. MOSES BLVD.
DAYTON OH
45417-3464
US

IV. Provider business mailing address

921 S. EDWIN C. MOSES BLVD
DAYTON OH
45417-3464
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-1376
  • Fax: 937-499-7813
Mailing address:
  • Phone: 937-461-1376
  • Fax: 937-499-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY D. SNIDER
Title or Position: CFO
Credential:
Phone: 937-278-2612