Healthcare Provider Details

I. General information

NPI: 1093827016
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GALAXY DR
EVANSVILLE IN
47715-1687
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-2822
  • Fax: 812-475-9140
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06-002280-1
License Number StateIN

VIII. Authorized Official

Name: PAUL PLEVYAK
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 502-213-1710