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Organization
WILLIAMSPORT FAMILY MEDICAL CENTER, LLC
Active
Organization
WILLIAMSPORT FAMILY MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN TANIS (EXECUTIVE DIRECTOR OF CONTRACT MGMT)
(856) 533-8762
Entity
Organization
Contact information
Practice address
422 PARK AVE, WILLIAMSPORT, PA 17701-4930
(570) 505-1123
(570) 505-1237
Mailing address
1317 ROUTE 73 STE 200, MOUNT LAUREL, NJ 08054-2202
(856) 439-6111
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
PA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Enumeration date
05/23/2012
Last updated
09/21/2021
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