Provider Demographics
NPI:1871717439
Name:GOOD SAMARITAN HEALTH CLINIC
Entity type:Organization
Organization Name:GOOD SAMARITAN HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:ED
Authorized Official - Phone:317-638-2862
Mailing Address - Street 1:11 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1871
Mailing Address - Country:US
Mailing Address - Phone:317-638-2862
Mailing Address - Fax:317-638-7993
Practice Address - Street 1:2716 E. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46206-1871
Practice Address - Country:US
Practice Address - Phone:317-638-2862
Practice Address - Fax:317-263-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QH0100X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service