Healthcare Provider Details

I. General information

NPI: 1265891881
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MAIN ST
MONROE CITY IN
47557-0006
US

IV. Provider business mailing address

520 S 7TH ST
VINCENNES IN
47591-1038
US

V. Phone/Fax

Practice location:
  • Phone: 812-743-5113
  • Fax: 812-743-2748
Mailing address:
  • Phone: 812-885-3193
  • Fax: 812-885-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT D MCLIN
Title or Position: CEO
Credential:
Phone: 812-885-3333