Organization
GOOD SAMARITAN PHYSICIAN SERVICES
Active
Other names
WellSpan Family Medicine - North Fourth Street
Organization subpart
No
Provider details
NPI number
Authorized official
JODY M BOGER (CREDENTIALING COORDINATOR)
(717) 270-7780
Entity
Organization
Contact information
Practice address
30 N 4TH ST, 2ND FLOOR, LEBANON, PA 17046-5606
(717) 274-0474
(717) 274-0673
Mailing address
PO BOX 300, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001864024
—
PA
Enumeration date
03/02/2007
Last updated
10/04/2016
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