GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC

Provider Demographics

• NPI: 1649432071
• Name: GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
• Entity type: Organization
• Organization Name: GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: ROBERT
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: MCLIN
• Authorized Official - Phone: 812-885-3333
• Mailing Address - Street 1: 1160 E SAINT CLAIR ST
• 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: 520 S 7TH ST
• Practice Address - City: VINCENNES
• Practice Address - State: IN
• Practice Address - Zip Code: 47591-1038
• Practice Address - Country: US
• Practice Address - Phone: 812-885-3333
• Practice Address - Fax: 812-885-3737
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-06-26
• Last Update Date: 2024-01-10

Provider Licenses

State	License ID	Taxonomies
IN		207Q00000X, 207R00000X, 207L00000X, 207RH0003X, 207V00000X, 208600000X, 208M00000X
		207RG0100X, 207RX0202X, 207X00000X, 207XX0005X, 261QR1300X, 363A00000X, 363L00000X, 363LA2100X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208M00000X	Allopathic & Osteopathic Physicians	Hospitalist		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207L00000X	Allopathic & Osteopathic Physicians	Anesthesiology		Group - Multi-Specialty
No	207RG0100X	Allopathic & Osteopathic Physicians	Internal Medicine	Gastroenterology	Group - Multi-Specialty
No	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207RX0202X	Allopathic & Osteopathic Physicians	Internal Medicine	Medical Oncology	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207XX0005X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Sports Medicine	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	261QR1300X	Ambulatory Health Care Facilities	Clinic/Center	Rural Health	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	201092760	Medicaid
IN	200922190	Medicaid
IN	201205250	Other	MEDICAID
IN	153904	Other	MEDICARE/OSCAR CERTIFICATION
	258190	Other	MEDICARE
IN	201092760	Other	MEDICAID
IN	201092760	Medicaid
IN	258190	Medicare PIN