Organization
GOOD SAMARITAN PHYSICIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY M BOGER (CREDENTIALING COORDINATOR)
(717) 270-7780
Entity
Organization
Contact information
Practice address
4TH AND WILLOW STREETS, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Mailing address
PO BOX 300, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001864024
—
PA
Enumeration date
07/14/2006
Last updated
11/25/2014
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