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General NPI Number Information
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NPI Number | 1336576875
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 520 S 7TH ST
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City | VINCENNES
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State | IN
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Zip | 47591-1038
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Country | US
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Telephone | 812-882-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 E SAINT CLAIR ST
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City | VINCENNES
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State | IN
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Zip | 47591-4853
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Country | US
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Telephone | 812-885-3453
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Fax | 812-885-8499
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Authorized Official
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Title or Position | CFO
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Name | MR. MATTHEW SCHUCKMAN
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Credential |
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Telephone | 812-882-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | IN
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