Williamsport Family Medical Center, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

WILLIAMSPORT FAMILY MEDICAL CENTER, LLC

Practice address

422 Park Ave
Williamsport, PA 17701-4930

Phone

(570) 505-1123

Fax

(570) 505-1237

NPI assigned

May 23, 2012

Last updated

Sep 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robyn Tanis

Title

Executive Director of Contract MGMT

Phone

(856) 533-8762

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Opioid treatment program

Medicare-enrolled since Jan 1, 2020

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1881954865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 PARK AVE",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177014930",
            "telephone_number": "570-505-1123",
            "fax_number": "570-505-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSPORT FAMILY MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-23",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neihl Williamson, PA-C
• Sasha N Williamson, RDH, PHDHP
• Williamsport Area Ambulance Service Cooperative (Susquehanna Regional EMS)
• Williamsport Area School District
• Williamsport Dental & Dentures, Inc
• Williamsport Home
• Williamsport North Operations LLC (Williamsport North Rehabilitation and Nursing Center)
• Williamsport North SNF Operations LLC
• Williamsport Obstetrics & Gynecology, P.C.
• Williamsport Orthopedic & Prosthetic Company Inc

• Methadone Clinic in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Methadone Clinic in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.