Healthcare Provider Details

I. General information

NPI: 1043576291
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 NW SAMARITAN DR SUITE 100
CORVALLIS OR
97330-3767
US

IV. Provider business mailing address

3517 NW SAMARITAN DR SUITE 100
CORVALLIS OR
97330-3767
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4280
  • Fax: 541-768-4931
Mailing address:
  • Phone: 541-768-4280
  • Fax: 541-768-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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