Provider Demographics
NPI:1629050646
Name:GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:812-885-3917
Mailing Address - Street 1:305 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1117
Mailing Address - Country:US
Mailing Address - Phone:812-885-8497
Mailing Address - Fax:812-885-8499
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034975A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200926130Medicaid
IN200922190Medicaid
IN200009110Medicaid
IN201092760Medicaid
IN200922190Medicaid
IN201092760Medicaid
IN258190GGGMedicare PIN
IN258190Medicare PIN