Provider Demographics
NPI:1346329232
Name:THE GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-7806
Mailing Address - Street 1:PO BOX 1281
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-274-7580
Mailing Address - Fax:717-228-0249
Practice Address - Street 1:FOURTH AND WALNUT STREETS
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-274-7580
Practice Address - Fax:717-228-0249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GOOD SAMARITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA072401207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1373454OtherHIGHMARK FREEDOM BLUE
005267OtherRAILROAD MEDICARE
PA1017455OtherGATEWAY MEDICARE ASSURED
PA145461OtherBS 65(MEDIGAP CROSS OVER)
PA1373454OtherHIGHMARK BLUE SHIELD
005267OtherSTERLING OPTION 1
005267OtherGEISINGER GOLD
PA116415000OtherFEDERAL WORK COMP
005267OtherADVANTRA
005267OtherHUMANA GOLD