1336184019 NPI number — GOOD SAMARITAN HOSPITAL

Table of content: (NPI 1336184019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336184019 NPI number — GOOD SAMARITAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN HOSPITAL
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:
CHI HEALTH GOOD SAMARITAN
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:
1336184019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 E 31ST ST
Provider Second Line Business Mailing Address:
BOX 1990
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68847-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-865-7100
Provider Business Mailing Address Fax Number:
308-865-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 E 31ST ST
Provider Second Line Business Practice Location Address:
BOX 1990
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68847-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-865-7100
Provider Business Practice Location Address Fax Number:
308-865-2913
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KUIPER
Authorized Official First Name:
EVERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO - CHI HEALTH
Authorized Official Telephone Number:
402-343-4420

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  070001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273R00000X , with the licence number: 070001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 070001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416A0800X , with the licence number: 070001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 070001 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100259643-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112385800 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3419 . This is a "BLUE CROSS - 1500 FORM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0130954301 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0034 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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