1023260924 NPI number — GOOD SAMARITIAN PHYSICIAN SERVICES

Table of content: (NPI 1023260924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023260924 NPI number — GOOD SAMARITIAN PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITIAN PHYSICIAN SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELLSPAN MEDICAL ONCOLOGY AND HEMATOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023260924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 MEMORY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-1405
Provider Business Mailing Address Fax Number:
717-851-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 TUCK ST
Provider Second Line Business Practice Location Address:
SECHLER FAMILY CANCER CENTER
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-7477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-274-8875
Provider Business Practice Location Address Fax Number:
717-270-2325
Provider Enumeration Date:
10/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SWEITZER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
AO
Authorized Official Telephone Number:
717-851-6838

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001864024 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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