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General NPI Number Information
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NPI Number | 1861660003
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 515 BAYOU ST
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City | VINCENNES
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State | IN
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Zip | 47591-1034
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Country | US
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Telephone | 812-885-2709
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Fax | 812-885-2729
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Provider Business Mailing Address
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Address Line | 515 BAYOU ST
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City | VINCENNES
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State | IN
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Zip | 47591-1034
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Country | US
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Telephone | 812-886-6800
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Fax | 812-886-6809
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | JOHN MANNING
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Credential |
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Telephone | 812-885-2709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4030CMHC
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License Number State | IN
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