Healthcare Provider Details

I. General information

NPI: 1982970828
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 NW SAMARITAN DR STE 202
CORVALLIS OR
97330-3785
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-753-5800
  • Fax:
Mailing address:
  • Phone: 541-768-6768
  • Fax: 541-768-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14-1074
License Number StateOR

VIII. Authorized Official

Name: JOSEPH M CAHILL III
Title or Position: CEO-GSRMC
Credential:
Phone: 541-768-7914