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1800 Market St Lewisburg PA 17837-1236 | |
| (570) 524-9477 | |
| (570) 524-9492 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1800 Market St, Lewisburg, Pennsylvania |
| Authorized Official Name and Position | Rita A. Rousseau (EXECUTIVE DIRECTOR OF COS) |
| Authorized Official Contact | 7177950368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
435 W 4th St Williamsport PA 17701-6001 Ph: (570) 322-7873 | 1800 Market St Lewisburg PA 17837-1236 Ph: (570) 524-9477 |
| NPI Number | 1376589507 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 11/07/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376589507 | NPI | - | NPPES |
| 301029 | Other | PA | VALUEOPTIONS |
| 02319100 | Other | PA | CAPITAL BLUE CROSS |
| 1007777400037 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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