Healthcare Provider Details

I. General information

NPI: 1316212624
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NW WALNUT BLVD SUITE 300
CORVALLIS OR
97330-3874
US

IV. Provider business mailing address

400 NW WALNUT BLVD STE 300
CORVALLIS OR
97330-3876
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4680
  • Fax:
Mailing address:
  • Phone: 541-768-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSIAH JOHNSON
Title or Position: CEO - GSRMC
Credential:
Phone: 541-768-5009