Healthcare Provider Details

I. General information

NPI: 1609279876
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 N MAIN ST
PRINCETON IN
47670-1514
US

IV. Provider business mailing address

314 N MAIN ST
PRINCETON IN
47670-1514
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-1071
  • Fax: 812-385-8793
Mailing address:
  • Phone: 812-385-1071
  • Fax: 812-385-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

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