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General NPI Number Information
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NPI Number | 1760510523
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN PHYSICIAN SERVICES
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 618 CORNWALL RD BUILDING 2
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City | LEBANON
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State | PA
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Zip | 17042-7089
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Country | US
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Telephone | 717-279-6700
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Fax | 717-279-6759
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Provider Business Mailing Address
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Address Line | P.O. BOX 300
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City | LEBANON
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State | PA
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Zip | 17042-0300
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Country | US
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Telephone | 717-270-7780
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Fax | 717-274-9746
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JODY M BOGER
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Credential |
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Telephone | 717-270-7780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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