Provider Demographics
NPI:1518123140
Name:WILLIAMSPORT PHYSICAL MEDICINE, INC.
Entity Type:Organization
Organization Name:WILLIAMSPORT PHYSICAL MEDICINE, INC.
Other - Org Name:NEUROPATHY CENTER OF NEPA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-322-5500
Mailing Address - Street 1:1101 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5411
Mailing Address - Country:US
Mailing Address - Phone:570-322-5500
Mailing Address - Fax:570-322-8100
Practice Address - Street 1:1101 E 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5411
Practice Address - Country:US
Practice Address - Phone:570-322-5500
Practice Address - Fax:570-322-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004453L111N00000X
PAMD 433098208100000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6141120001Medicare NSC
133940Medicare PIN