1336184019 NPI number — GOOD SAMARITAN HOSPITAL

Table of Contents

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:
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:
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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