Provider Demographics
NPI:1407928500
Name:THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA
Other - Org Name:WELLSPAN GOOD SAMARITAN HOSPITAL ACUTE CARE HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-7503
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6429
Practice Address - Street 1:252 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6123
Practice Address - Country:US
Practice Address - Phone:717-270-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207ZC0006X, 261QA1903X, 261QR0200X, 261QX0203X
PA072401282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007732780059Medicaid
PA1007732780058Medicaid
PA1007732780065Medicaid
PA1007732780067Medicaid
PA1007732780060Medicaid
PA1007732780068Medicaid
PA1007732780069Medicaid
PA1007732780061Medicaid
PA1007732780056Medicaid
PA1007732780055Medicaid
PA1007732780063Medicaid
PA1007732780066Medicaid
PA1007732780004Medicaid
PA1007732780062Medicaid
PA08274OtherHEALTH PARTNERS
PA390066OtherKEYSTONE HEALTH PLAN CENT
390066OtherHUMANA GOLD
390066OtherSTERLING OPTION 1