Provider Demographics
NPI:1174031256
Name:GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-494-7800
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0556
Mailing Address - Country:US
Mailing Address - Phone:812-494-9501
Mailing Address - Fax:812-494-9502
Practice Address - Street 1:1027 WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2240
Practice Address - Country:US
Practice Address - Phone:812-494-7500
Practice Address - Fax:812-494-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30021631Medicaid