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
Mailing address
PO BOX 503927, SAINT LOUIS, MO 63150-0001
(618) 899-4600
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0004705
IL
282N00000X
General Acute Care Hospital
Primary
0004705
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014
BLUE CROSS/BLUE SHIELD
IL
01
—
003891
HEALTH ALLIANCE NUMBER
IL
01
—
103233
HEALTHLINK NUMBER
IL
01
—
140112100
ACS OWCP NUMBER
IL
01
—
33898
GROUP HEALTH PLAN NUMBER
IL
01
—
39584100
BLACK LUNG NUMBER
IL
Enumeration date
07/21/2006
Last updated
11/27/2023
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