Basic Information
| Provider Information | |||||||||
| NPI: | 1336184019 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOOD SAMARITAN HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHI HEALTH GOOD SAMARITAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 E 31ST ST | ||||||||
| Address2: | BOX 1990 | ||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688472926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088657100 | ||||||||
| FaxNumber: | 3088652913 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 E 31ST ST | ||||||||
| Address2: | BOX 1990 | ||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688472926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088657100 | ||||||||
| FaxNumber: | 3088652913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | KUIPER | ||||||||
| AuthorizedOfficialFirstName: | EVERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO - CHI HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 4023434420 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 070001 | NE | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 273R00000X | 070001 | NE | N | Hospital Units | Psychiatric Unit | 3416A0800X | 070001 | NE | N | Transportation Services | Ambulance | Air Transport | 3416L0300X | 070001 | NE | N | Transportation Services | Ambulance | Land Transport | 282N00000X | 070001 | NE | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100259643-00 | 05 | NE | MEDICAID | 112385800 | 05 | WY | MEDICAID | 3419 | 01 | BLUE CROSS - 1500 FORM | OTHER | 0130954301 | 05 | KS | MEDICAID | 0034 | 01 | BLUE CROSS | OTHER |