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Organization
LYCOMING PHYSICIAN SERVICES,INC.
Active
Organization
LYCOMING PHYSICIAN SERVICES,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT JOHN LAGERMAN JR. MBA (ADMINISTRATOR)
(570) 743-1703
Entity
Organization
Contact information
Practice address
3040 N SUSQUEHANNA TRL, SHAMOKIN DAM, PA 17876-9113
(570) 743-1703
(570) 743-1728
Mailing address
3040 N SUSQUEHANNA TRL, P.O. BOX 129, SHAMOKIN DAM, PA 17876-9113
(717) 743-1703
(570) 743-1728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240488YHMK
MEDICARE PTAN
PA
Enumeration date
02/14/2012
Last updated
02/01/2013
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