Healthcare Provider Details

I. General information

NPI: 1013326537
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CORVALLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 SW 30TH STREET
CORVALLIS OR
97331-8629
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-7700
  • Fax: 541-768-9784
Mailing address:
  • Phone: 541-768-7700
  • Fax: 541-768-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

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