| White Deer Run Llc | |
|
520 W 4th St Williamsport PA 17701-6038 | |
| (570) 322-4836 | |
| (570) 322-4769 |
| Full Name | White Deer Run Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 520 W 4th St, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Christopher Howard (VP AND SECRETARY) |
| Authorized Official Contact | 6158616000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White Deer Run Llc 520 W 4th St Williamsport PA 17701-6038 Ph: (570) 322-4836 | White Deer Run Llc 520 W 4th St Williamsport PA 17701-6038 Ph: (570) 322-4836 |
| NPI Number | 1053617118 |
|---|---|
| Provider Enumeration Date | 02/07/2011 |
| Last Update Date | 10/19/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053617118 | NPI | - | NPPES |
| 1007567870061 | Medicaid | PA | |
| 1007567870091 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 417040 (Pennsylvania) | Primary |
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