1265891881 NPI number — GOOD SAMARITAN HOSPITAL

Table of content: (NPI 1265891881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265891881 NPI number — GOOD SAMARITAN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
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:
Provider Other Organization Name Type Code:
6
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:
1265891881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2016
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:
812-885-3193
Provider Business Mailing Address Fax Number:
812-885-3737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE CITY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47557-0006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-743-5113
Provider Business Practice Location Address Fax Number:
812-743-2748
Provider Enumeration Date:
02/11/2016

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:
812-885-3333

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 247100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 16-005038-1 . This is a "LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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