Provider Demographics
NPI:1073153474
Name:GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL
Other - Org Name:CENTER FOR THERAPY AND SPORTS PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:1160 E SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4853
Mailing Address - Country:US
Mailing Address - Phone:812-885-3453
Mailing Address - Fax:812-885-8499
Practice Address - Street 1:2020 S CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5576
Practice Address - Country:US
Practice Address - Phone:812-885-3011
Practice Address - Fax:812-885-3217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty