Organization
GOOD SAMARITAN REGIONAL HEALTH CENTER
Active
Other names
SSM Health Good Samaritan Hospital - Mt. Vernon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY BRADFORD (PRESIDENT)
(618) 899-1001
Entity
Organization
Contact information
Practice address
1 GOOD SAMARITAN WAY, MOUNT VERNON, IL 62864-2402
(618) 899-4600
(618) 532-9365
Mailing address
PO BOX 503927, SAINT LOUIS, MO 63150-0001
(618) 899-4600
(618) 532-9365
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0004705
IL
207RI0011X
Interventional Cardiology Physician
0004705
IL
208100000X
Physical Medicine & Rehabilitation Physician
0004705
IL
2084N0400X
Neurology Physician
0004705
IL
2085R0001X
Radiation Oncology Physician
0004705
IL
2085R0202X
Diagnostic Radiology Physician
0004705
IL
227800000X
Certified Respiratory Therapist
0004705
IL
227900000X
Registered Respiratory Therapist
0004705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33898
GROUP HEALTH PLAN
IL
01
—
4115179
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/08/2006
Last updated
11/27/2023
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