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General NPI Number Information
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NPI Number | 1861752073
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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 | 05/22/2012
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 30 N 4TH ST 4TH AND WILLOW STREETS
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City | LEBANON
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State | PA
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Zip | 17046-4808
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Country | US
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Telephone | 717-274-0474
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Fax | 717-274-0673
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Provider Business Mailing Address
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Address Line | PO 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 | 717-272-9746
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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