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General NPI Number Information
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NPI Number | 1083342356
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL CORVALLIS
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 845 SW 30TH ST
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City | CORVALLIS
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State | OR
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Zip | 97331-8629
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Country | US
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Telephone | 541-768-7700
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Fax | 541-768-9784
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Provider Business Mailing Address
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Address Line | PO BOX 1189
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City | CORVALLIS
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State | OR
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Zip | 97339-1189
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Country | US
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Telephone | 541-768-7700
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Fax | 541-768-9784
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Authorized Official
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Title or Position | CEO-GSRMC
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Name | LAURA ALFERD HENNUM
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Credential |
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Telephone | 541-768-5011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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