1790904225 NPI number — GOOD SAMARITAN HOSPITAL CORVALLIS

Table of content: MARY KATHLEEN GORTAT RPH (NPI 1154384683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790904225 NPI number — GOOD SAMARITAN HOSPITAL CORVALLIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN HOSPITAL CORVALLIS
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:
1790904225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97339-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-768-5144
Provider Business Mailing Address Fax Number:
541-768-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3509 NW SAMARITAN DRIVE SUITE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORVALLIS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97330-3766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-768-5144
Provider Business Practice Location Address Fax Number:
541-768-5201
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAHILL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO-GSRMC
Authorized Official Telephone Number:
541-768-7914

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  14-1074 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 72652 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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