Healthcare Provider Details

I. General information

NPI: 1033393749
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COLLEGE AVE
VINCENNES IN
47591-5663
US

IV. Provider business mailing address

PO BOX 221648
LOUISVILLE KY
40252-1648
US

V. Phone/Fax

Practice location:
  • Phone: 812-886-9870
  • Fax: 812-886-9871
Mailing address:
  • Phone: 502-412-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number07-003237-1
License Number StateIN

VIII. Authorized Official

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