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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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