| Good Samaritan Physician Services Family Support | |
|
30 N 4th St 4th And Willow Streets Lebanon PA 17046-4808 | |
| (717) 274-0474 | |
| (717) 274-0673 |
| Full Name | Good Samaritan Physician Services Family Support |
|---|---|
| Speciality | Social Worker |
| Location | 30 N 4th St, Lebanon, Pennsylvania |
| Authorized Official Name and Position | Jody M Boger (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 7172707780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Samaritan Physician Services Family Support Po Box 300 Lebanon PA 17042-0300 Ph: (717) 270-7780 | Good Samaritan Physician Services Family Support 30 N 4th St 4th And Willow Streets Lebanon PA 17046-4808 Ph: (717) 274-0474 |
| NPI Number | 1861752073 |
|---|---|
| Provider Enumeration Date | 05/22/2012 |
| Last Update Date | 11/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861752073 | NPI | - | NPPES |
| 001864024 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
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