Provider Demographics
NPI:1639206428
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:VP OF FINANCE
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:812-885-3891
Mailing Address - Street 1:700 WILLOW ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1029
Mailing Address - Country:US
Mailing Address - Phone:812-885-8040
Mailing Address - Fax:812-885-8040
Practice Address - Street 1:700 WILLOW ST STE 200
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1029
Practice Address - Country:US
Practice Address - Phone:812-885-8040
Practice Address - Fax:812-885-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036900A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100384170Medicaid
IN000000594299OtherANTHEM
INP00658256OtherRAILROAD MEDICARE
IN444370Medicare PIN
IN100384170Medicaid
IN258190EMedicare PIN
IN000000594299OtherANTHEM
IN444370AMedicare PIN