Healthcare Provider Details

I. General information

NPI: 1295103448
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 NW ELKS DR
CORVALLIS OR
97330-3744
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5220
  • Fax: 541-768-5303
Mailing address:
  • Phone: 541-768-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number14-1074
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14-1074
License Number StateOR

VIII. Authorized Official

Name: BECKY A. PAPE
Title or Position: COO
Credential: MPA
Phone: 541-768-5009