Organization
GOOD SAMARITAN PHYSICIAN SERVICE
Active
Other names
WellSpan Pulmonary and Sleep Medicine - Lebanon
Organization subpart
No
Provider details
NPI number
Authorized official
JODY M BOGER (CREDENTIALING COORDINATOR)
(717) 270-7780
Entity
Organization
Contact information
Practice address
850 TUCK ST, LEBANON, PA 17042-7477
(717) 272-8173
(717) 272-4029
Mailing address
PO BOX 300, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001864024
—
PA
Enumeration date
06/13/2014
Last updated
10/05/2016
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