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GOOD SAMARITAN PHYSICIAN SERVICES NPI 1316076961


NPI Information

NPI: 1316076961
Provider Name: GOOD SAMARITAN PHYSICIAN SERVICES

Doing Business As: WELLSPAN FAMILY MEDICINE - NORTH FOURTH STREET

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 39D0185947

Address:
30 N 4TH ST
2ND FLOOR
LEBANON, PA
ZIP 17046
Phone: (717) 274-0474
Get Directions

GOOD SAMARITAN PHYSICIAN SERVICES is a family medicine in Lebanon, PA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. GOOD SAMARITAN PHYSICIAN SERVICES NPI is 1316076961. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Wellspan Family Medicine - North Fourth Street.

The provider's business location address is:

30 N 4TH ST
2ND FLOOR
LEBANON, PA
ZIP 17046-606
Phone: (717) 274-0474
Fax: (717) 274-0673

The provider's authorized official is Jody M Boger .
The authorized official title is Credentialing Coordinator and has the following contact phone number (717) 270-7780.

The CLIA number assigned to this NPI record is 39D0185947 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 3/2/2007 and was last updated on 10/4/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207V00000XObstetrics & GynecologyNo
2208000000XPediatricsNo
3207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1047659MEDICARE PINPENNSYLVANIA
2001864024MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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