1902955453 NPI number — GOOD SAMARITAN HOSPITAL

Table of content: (NPI 1902955453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902955453 NPI number — GOOD SAMARITAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
GOOD SAMARITAN HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD SAMARITAN HOSPICE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902955453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINCENNES
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47591-1038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-885-5220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11190 COUNTRY CLUB ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-943-4663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCLIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
812-885-3193

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2001790 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)