1700549904 NPI number — GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC

Table of content: (NPI 1700549904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700549904 NPI number — GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
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:
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:
1700549904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 E SAINT CLAIR 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:
47591-4853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-885-3106
Provider Business Mailing Address Fax Number:
812-885-8499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 N 1ST ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINCENNES
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47591-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-885-6840
Provider Business Practice Location Address Fax Number:
812-885-6841
Provider Enumeration Date:
10/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUCKMAN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
812-882-5220

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com