1417949892 NPI number — GOOD SAMARITAN HOSPITAL

Table of content: (NPI 1417949892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417949892 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:
Provider Other Organization Name Type Code:
6
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:
1417949892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98371-0192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-697-7600
Provider Business Mailing Address Fax Number:
253-697-5191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 E MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-697-7600
Provider Business Practice Location Address Fax Number:
253-691-9598
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCKINNEY
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
253-697-7600

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  IS302 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004 . This is a "CHAMPUS HOME HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7330079 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1258 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: WA2923 . This is a "MOLINA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0543130001 . This is a "CIGNA MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: GO4586 . This is a "REGENCE HIT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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