Healthcare Provider Details

I. General information

NPI: 1619896073
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 NW CIRCLE BLVD STE 101
CORVALLIS OR
97330-1967
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-8020
  • Fax: 541-255-3180
Mailing address:
  • Phone: 541-768-4410
  • Fax: 541-768-4613

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