Provider Demographics
NPI:1609952761
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:2006-10-31
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA072401207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1365669OtherHIGHMARK FREEDOM BLUE
400547OtherADVANTRA
400547OtherHUMANA GOLD
PA1365669OtherHIGHMARK BLUE SHIELD
400547OtherGEISINGER GOLD
400547OtherSTERLING OPTION 1
1520460OtherGATEWAY MEDICARE ASSURED
PA400547OtherBS 65(MEDIGAP CROSS OVER)
400547OtherRAILROAD MEDICARE
PA400547OtherBS 65(MEDIGAP CROSS OVER)