Organization
GOOD SAMARITAN PHYSICIAN SERVICES
Active
Other names
WellSpan Family Medicine - West Cornwall
Organization subpart
No
Provider details
NPI number
Authorized official
JODY M BOGER (CREDENTIALING COORDINATOR)
(717) 270-7780
Entity
Organization
Contact information
Practice address
101 FAIRVIEW CIR, LEBANON, PA 17042-9581
(717) 279-7303
(717) 279-7471
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001864024
—
PA
Enumeration date
11/27/2013
Last updated
10/20/2016
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