# GOOD SAMARITAN PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WellSpan Family Medicine - North Fourth Street
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316076961
- **Authorized official:** JODY M BOGER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (717) 270-7780

## Contact information

- **Practice address:** 30 N 4TH ST, 2ND FLOOR, LEBANON, PA 17046-5606
- **Practice address phone:** (717) 274-0474
- **Practice address fax:** (717) 274-0673
- **Mailing address:** PO BOX 300, LEBANON, PA 17042-0300
- **Mailing address phone:** (717) 270-7780
- **Mailing address fax:** (717) 274-9746

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 03/02/2007
- **Last updated:** 10/04/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001864024 | — | PA |