NPIMap

Organization Active NPI

Lycoming Physical Medicine PC

  • Chiropractor
  • Williamsport, PA
National Provider Identifier
1891118667
Registry record updated Jun 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC004453L Issued in PA
Legal business name
LYCOMING PHYSICAL MEDICINE PC
Practice address
1111 E 3Rd St
Williamsport, PA 17701-5411
Phone
(570) 916-4897
Fax
(570) 322-8100
NPI assigned
Jan 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2015

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

Authorized official

Name
Dr. Mark Allen Hampton, D.C.
Title
Ceo
Phone
(570) 916-4897

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X DC004453L PA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MD045007L PA
Durable Medical Equipment & Medical Supplies 332B00000X MD070043L PA

Addresses

Primary practice location

1111 E 3Rd St
Williamsport, PA 17701-5411

Mailing address

1111 E 3Rd St
Williamsport, PA 17701-5411
Phone (570) 916-4897

Other identifiers 1

IdentifierTypeStateIssuer
DC004453LOtherPALICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1891118667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 E 3RD ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015411",
            "telephone_number": "570-916-4897",
            "fax_number": "570-322-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E 3RD ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177015411",
            "telephone_number": "570-916-4897",
            "fax_number": "570-322-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING PHYSICAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-29",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "HAMPTON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-916-4897",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC004453L",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD045007L",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "MD070043L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "DC004453L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 12, 2015; 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.