Provider Demographics
NPI:1841322278
Name:GOOD SAMARITAN PEDIATRICS 503 OAK STREET
Entity type:Organization
Organization Name:GOOD SAMARITAN PEDIATRICS 503 OAK STREET
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-272-4451
Mailing Address - Street 1:P.O. BOX 300
Mailing Address - Street 2:4TH & WILLOW STREET
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042
Mailing Address - Country:US
Mailing Address - Phone:717-272-4451
Mailing Address - Fax:717-272-4532
Practice Address - Street 1:503 OAK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6246
Practice Address - Country:US
Practice Address - Phone:717-272-7695
Practice Address - Fax:717-272-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047659Medicare ID - Type Unspecified