Provider Demographics
NPI:1033393749
Name:GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL
Other - Org Name:BRIDGEPOINTE HEALTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-882-5220
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:1900 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5663
Practice Address - Country:US
Practice Address - Phone:812-886-9870
Practice Address - Fax:812-886-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-003237-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200374360Medicaid
IN155696Medicare Oscar/Certification