Good Samaritan Family Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Vincennes, IN
NPI 1487424628 · NPPES record last updated Jan 8, 2024
Key facts
- NPI
- 1487424628
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GOOD SAMARITAN FAMILY HEALTH CENTER, INC
- Practice address
- 1513 Main St FL 3
Vincennes, IN 47591-6238 - Phone
- (812) 885-2720
- Fax
- (812) 885-2722
- NPI assigned
- Jan 8, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- GOOD SAMARITAN FAMILY HEALTH CENTER, INC
Authorized official
- Name
- Jennifer Emmons
- Title
- Ceo
- Phone
- (812) 494-9501
Corporate family (same tax ID) 29
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Federally qualified health center certification: CCN C51041
- Legal name
- GOOD SAMARITAN FAMILY HEALTH CENTER INC
- Doing business as
- FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 18, 2024
- Last certification
- Jun 18, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 25, 2017 in IN
- Enrollment address
- 1513 Main St
FL 3
Vincennes, IN 47591-6238
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Stanley Graber |
Corporate Officer |
Jul 1, 2023 | |
| Bridgett Bilskie |
W-2 Managing Employee |
Jul 1, 2023 | |
| Stormey Wiegman |
W-2 Managing Employee |
Apr 15, 2024 | |
| Kolby Kerzan |
Other |
Sep 1, 2023 | |
| Jennifer Emmons |
5% Or Greater Direct Ownership Interest |
Jul 1, 2023 | 100% |
| Traci French |
Corporate Officer |
Jul 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240621000284 | IN | Part a Provider - Federally Qualified Health Center (FQHC) | 5294099321 | Practice locations: Vincennes, IN |
National Provider Directory
- Tax ID family
- Good Samaritan Family Health Center Inc
- Part of
- Good Samaritan Family Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1513 Main St FL 3
Vincennes, IN 47591-6238
Mailing address
PO Box 556
Vincennes, IN 47591-0556
Phone (812) 494-9501
Other names
- Family Health Center
Other providers in Vincennes, IN
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
- Good Samaritan Family Health Center, Inc
All providers in Vincennes, IN · Federally Qualified Health Center (FQHC) in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.