NPIMap

Organization Active NPI

Lycoming Physician Services,Inc.

  • Family Medicine Physician
  • Shamokin Dam, PA
National Provider Identifier
1972876472
Registry record updated Feb 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LYCOMING PHYSICIAN SERVICES,INC.
Practice address
3040 N Susquehanna TRL
Shamokin Dam, PA 17876-9113
Phone
(570) 743-1703
Fax
(570) 743-1728
NPI assigned
Feb 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2013

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

Authorized official

Name
Albert John Lagerman Jr., MBA
Title
Administrator
Phone
(570) 743-1703

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

3040 N Susquehanna TRL
Shamokin Dam, PA 17876-9113

Mailing address

3040 N Susquehanna TRL
P.O. Box 129
Shamokin Dam, PA 17876-9113
Phone (717) 743-1703

Other identifiers 1

IdentifierTypeStateIssuer
240488YHMKOtherPAMEDICARE PTAN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1972876472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 N SUSQUEHANNA TRL",
            "address_2": "P.O. BOX 129",
            "city": "SHAMOKIN DAM",
            "state": "PA",
            "postal_code": "178769113",
            "telephone_number": "717-743-1703",
            "fax_number": "570-743-1728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 N SUSQUEHANNA TRL",
            "city": "SHAMOKIN DAM",
            "state": "PA",
            "postal_code": "178769113",
            "telephone_number": "570-743-1703",
            "fax_number": "570-743-1728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING PHYSICIAN SERVICES,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-14",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "LAGERMAN",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-743-1703",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "240488YHMK",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shamokin Dam, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2013; 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.