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General NPI Number Information
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NPI Number | 1871717439
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HEALTH CLINIC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2716 E. WASHINGTON STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1871
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Country | US
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Telephone | 317-638-2862
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Fax | 317-263-9907
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Provider Business Mailing Address
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Address Line | 11 EASTERN AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-1871
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Country | US
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Telephone | 317-638-2862
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Fax | 317-638-7993
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DANIEL J. EVANS
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Credential | E.D
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Telephone | 317-638-2862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 261QH0100X
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License Number State | IN
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