| Laceyville Office | |
|
104 Main St. Laceyville PA 18623 | |
| (570) 869-2988 | |
| (570) 869-2891 |
| Full Name | Laceyville Office |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Main St., Laceyville, Pennsylvania |
| Authorized Official Name and Position | Lawrence Tama (PRESIDENT/OWNER) |
| Authorized Official Contact | 5702656300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laceyville Office 71 Hospital Drive Towanda PA 18848-9706 Ph: (570) 265-6300 | Laceyville Office 104 Main St. Laceyville PA 18623 Ph: (570) 869-2988 |
| NPI Number | 1023272333 |
|---|---|
| Provider Enumeration Date | 07/16/2008 |
| Last Update Date | 08/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023272333 | NPI | - | NPPES |
| 1007556720029 | Medicaid | PA | |
| 100755672 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |