Healthcare Provider Details

I. General information

NPI: 1487731477
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E ILLINOIS ST
PETERSBURG IN
47567-8026
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 812-354-3001
  • Fax: 812-354-3008
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060002521
License Number StateIN

VIII. Authorized Official

Name: ROBERT MCLIN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 812-882-5220