Healthcare Provider Details

I. General information

NPI: 1144083635
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S 5TH ST STE A
VINCENNES IN
47591-1117
US

IV. Provider business mailing address

1620 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051-3219
US

V. Phone/Fax

Practice location:
  • Phone: 812-255-2000
  • Fax: 812-291-9612
Mailing address:
  • Phone: 817-913-7247
  • Fax: 817-720-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

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