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General NPI Number Information
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NPI Number | 1205045770
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 3509 NW SAMARITAN DR
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City | CORVALLIS
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State | OR
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Zip | 97330-3766
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Country | US
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Telephone | 541-768-6833
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Fax | 541-768-5278
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Provider Business Mailing Address
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Address Line | 3509 NW SAMARITAN DR
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City | CORVALLIS
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State | OR
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Zip | 97330-3766
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Country | US
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Telephone | 541-768-6833
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Fax | 541-768-5278
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. MIALEE WOMACK
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Credential | LCSW
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Telephone | 541-768-6833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | L3743
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License Number State | OR
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