Organization
GOOD SAMARITAN PHYSICIAN SERVICES
Active
Other names
Good Samaritan Wound Care Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JODY M BOGER (CREDENTIALING COORDINATOR)
(717) 270-7780
Entity
Organization
Contact information
Practice address
840 TUCK ST, LEBANON, PA 17042-7477
(717) 675-2545
(717) 675-2550
Mailing address
PO BOX 300, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
—
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001864024
—
PA
Enumeration date
03/26/2013
Last updated
10/04/2016
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