Healthcare Provider Details

I. General information

NPI: 1639176373
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S 7TH ST
VINCENNES IN
47591-1038
US

IV. Provider business mailing address

520 S 7TH ST
VINCENNES IN
47591-1038
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-3292
  • Fax:
Mailing address:
  • Phone: 812-885-3292
  • Fax: 812-885-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4030
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4030
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4030
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4030
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4030
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM THACKER
Title or Position: CEO
Credential:
Phone: 812-882-5220