Healthcare Provider Details

I. General information

NPI: 1710162623
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 NW SAMARITAN DR SUITE201
CORVALLIS OR
97330-4714
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6300
  • Fax: 541-768-6301
Mailing address:
  • Phone: 541-768-4300
  • Fax: 541-768-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO20838
License Number StateOR

VIII. Authorized Official

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