NPIMap

Organization Active NPI

Lycoming-Clinton Joinder Board

  • Health Maintenance Organization
  • Williamsport, PA
National Provider Identifier
1275739955
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
LYCOMING-CLINTON JOINDER BOARD
Practice address
200 East St
Williamsport, PA 17701-6613
Phone
(570) 326-0924
Fax
(570) 326-1348
NPI assigned
Jun 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ellen Didomenico
Title
Human Services Director
Phone
(570) 323-6467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

200 East St
Williamsport, PA 17701-6613

Mailing address

200 East St
Williamsport, PA 17701-6613
Phone (570) 326-0924

Other identifiers 1

IdentifierTypeStateIssuer
1007332180012OtherPACAPITATION

Other names 1

  • Lycoming Clinton MHMR Program Other name

National Provider Directory

National Provider Directory
Tax ID family
Lycoming-Clinton Joinder Board4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 East St
Williamsport, PA 17701
Phone (570) 326-0924

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275739955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 EAST ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016613",
            "telephone_number": "570-326-0924",
            "fax_number": "570-326-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177016613",
            "telephone_number": "570-326-0924",
            "fax_number": "570-326-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING-CLINTON JOINDER BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIDOMENICO",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "HUMAN SERVICES DIRECTOR",
        "authorized_official_telephone_number": "570-323-6467"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITATION",
            "identifier": "1007332180012",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lycoming Clinton MHMR Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.