1609868413 NPI number — GOOD SAMARITAN HOSPITAL

Table of content: (NPI 1609868413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609868413 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:
MULTICARE GOOD SAMARITAN HOME HEALTH
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:
1609868413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98415-0200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-301-6400
Provider Business Mailing Address Fax Number:
253-301-6528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 S FIFE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98409-7309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-301-6400
Provider Business Practice Location Address Fax Number:
253-301-6528
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-301-6400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: GO1222 . This is a "REGENCE HOME HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9007618 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0439370003 . This is a "CIGNA MEDICARE" 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: 9166505 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004 . This is a "CHAMPUS HOME HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1258 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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