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General NPI Number Information
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NPI Number | 1487758801
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN REGIONAL HEALTH CENTER
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1 GOOD SAMARITAN WAY
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2402
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Country | US
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Telephone | 618-899-4600
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Fax | 618-532-9365
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Provider Business Mailing Address
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Address Line | PO BOX 503927
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 618-899-4600
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Fax | 618-532-9365
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEREMY BRADFORD
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Credential |
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Telephone | 618-899-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0004705
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0004705
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 0004705
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 0004705
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0004705
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 0004705
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | 0004705
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0004705
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License Number State | IL
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