1013116060 NPI number — GOOD SAMARITAN HOSPITAL, INC.

Table of content: (NPI 1013116060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013116060 NPI number — GOOD SAMARITAN HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. MARY'S GOOD SAMARITAN HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013116060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 LAKE OCONEE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30642-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-453-7331
Provider Business Mailing Address Fax Number:
706-453-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 LAKE OCONEE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30642-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-453-7331
Provider Business Practice Location Address Fax Number:
706-453-2696
Provider Enumeration Date:
07/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
706-389-3938

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  066-638 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000001328S . This is a "SWING" identifier , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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