Healthcare Provider Details

I. General information

NPI: 1730455577
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 NW SAMARITAN DR STE 215
CORVALLIS OR
97330-3893
US

IV. Provider business mailing address

3509 NW SAMARITAN DR STE 215
CORVALLIS OR
97330-3893
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5235
  • Fax: 541-768-5201
Mailing address:
  • Phone: 541-768-5235
  • Fax: 541-768-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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