15D1055237 CLIA NUMBER - GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC

Laboratory Demographics

  • CLIA Code: 15D1055237
  • Facility Name: GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
  • Facility Address: 700 WILLOW ST, STE 203
    VINCENNES, IN
    ZIP 47591
  • Facility Phone: 812 882-1000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DUSTIN BLACKWELL
  • NPI Number: 1164878583
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 15D1055237
LAB Type Physician Office
Facility Name GOOD SAMARITAN HOSPITAL PHYSICIAN SERVICES, INC
Street 700 WILLOW ST, STE 203
City VINCENNES
State IN
ZIP 47591
Phone 812 882-1000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/13/2024
Certificate Expiration Date 6/12/2026
Facility Type Physician Office
Lab Director DUSTIN BLACKWELL

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This page was last updated on: 9/29/2025