Organization
GOOD SAMARITAN COMMUNITY HEALTHCARE
Active
Other names
Good Samaritan Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R LONG III (CEO)
(253) 697-2102
Entity
Organization
Contact information
Practice address
16515 MERIDIAN E, SUITE 104A, PUYALLUP, WA 98375-6251
(253) 697-3030
(253) 697-8190
Mailing address
PO BOX 40, PUYALLUP, WA 98371-0137
(253) 697-5502
(253) 697-5510
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0122524
L & I NUMBER
WA
01
—
3006G0
REGENCE GROUP RIDER NUMBE
WA
05
—
7121940
—
WA
Enumeration date
05/19/2006
Last updated
09/11/2025
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