APPLEGATE RECOVERY WILLIAMSPORT
Complete NPI Record 1588905723
Family Medicine - Addiction Medicine in Williamsport, PA

NPI Status: Active since March 13, 2013

Contact Information

1101 E 3RD ST
WILLIAMSPORT, PA
ZIP 17701
Phone: (570) 505-3180
Fax: (570) 505-3184

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  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Title or Position
  25. Authorized Official Telephone Number
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Healthcare Provider Taxonomy Code 2
  31. Provider License Number 2
  32. Provider License Number State Code 2
  33. Healthcare Provider Primary Taxonomy Switch 2
  34. Healthcare Provider Taxonomy Code 3
  35. Provider License Number 3
  36. Provider License Number State Code 3
  37. Healthcare Provider Primary Taxonomy Switch 3
  38. Healthcare Provider Taxonomy Code 4
  39. Provider License Number 4
  40. Healthcare Provider Primary Taxonomy Switch 4
  41. Healthcare Provider Taxonomy Code 5
  42. Provider License Number 5
  43. Provider License Number State Code 5
  44. Healthcare Provider Primary Taxonomy Switch 5
  45. Healthcare Provider Taxonomy Code 6
  46. Provider License Number 6
  47. Provider License Number State Code 6
  48. Healthcare Provider Primary Taxonomy Switch 6
  49. Healthcare Provider Taxonomy Code 7
  50. Provider License Number 7
  51. Provider License Number State Code 7
  52. Healthcare Provider Primary Taxonomy Switch 7
  53. Healthcare Provider Taxonomy Code 8
  54. Provider License Number 8
  55. Provider License Number State Code 8
  56. Healthcare Provider Primary Taxonomy Switch 8
  57. Healthcare Provider Taxonomy Code 9
  58. Provider License Number 9
  59. Provider License Number State Code 9
  60. Healthcare Provider Primary Taxonomy Switch 9
  61. Healthcare Provider Taxonomy Code 10
  62. Provider License Number 10
  63. Provider License Number State Code 10
  64. Healthcare Provider Primary Taxonomy Switch 10
  65. Healthcare Provider Taxonomy Code 11
  66. Provider License Number 11
  67. Provider License Number State Code 11
  68. Healthcare Provider Primary Taxonomy Switch 11
  69. Healthcare Provider Taxonomy Code 12
  70. Provider License Number 12
  71. Provider License Number State Code 12
  72. Healthcare Provider Primary Taxonomy Switch 12
  73. Healthcare Provider Taxonomy Code 13
  74. Provider License Number 13
  75. Provider License Number State Code 13
  76. Healthcare Provider Primary Taxonomy Switch 13
  77. Healthcare Provider Taxonomy Code 14
  78. Healthcare Provider Primary Taxonomy Switch 14
  79. Is Organization Subpart
  80. Healthcare Provider Taxonomy Group 1
  81. Healthcare Provider Taxonomy Group 2
  82. Healthcare Provider Taxonomy Group 3
  83. Healthcare Provider Taxonomy Group 4
  84. Healthcare Provider Taxonomy Group 5
  85. Healthcare Provider Taxonomy Group 6
  86. Healthcare Provider Taxonomy Group 7
  87. Healthcare Provider Taxonomy Group 8
  88. Healthcare Provider Taxonomy Group 9
  89. Healthcare Provider Taxonomy Group 10
  90. Healthcare Provider Taxonomy Group 11
  91. Healthcare Provider Taxonomy Group 12
  92. Healthcare Provider Taxonomy Group 13
  93. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1588905723. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1588905723
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: APPLEGATE RECOVERY WILLIAMSPORT
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 1720 LAKEPOINTE DR STE 117
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: LEWISVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TX
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 750576425
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2143793300
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 1101 E 3RD ST
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WILLIAMSPORT
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: PA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 177015411
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 5705053180
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 5705053184
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/13/2013
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/29/2024
The date that a record was last updated or changed.
Authorized Official Last Name: JARVIE
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: BRUCE
The first name of the authorized official.
Authorized Official Title or Position: VP, TREASURER
The title or position of the authorized official.
Authorized Official Telephone Number: 2143793300
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207LA0401X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: MD042726L
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: PA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207LP2900X
Provider License Number 2: MD042726L
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: PA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207PE0004X
Provider License Number 3: MD443569
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: PA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 207Q00000X
Provider License Number 4: MD042726L
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207QA0401X
Provider License Number 5: MD042726L
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: PA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: Y
Healthcare Provider Taxonomy Code 6: 207QA0401X
Provider License Number 6: OS014721
Provider License Number State Code 6: PA
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 207RA0401X
Provider License Number 7: MD018954E
Provider License Number State Code 7: PA
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 207RG0300X
Provider License Number 8: MD045007L
Provider License Number State Code 8: PA
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 207V00000X
Provider License Number 9: MD036563L
Provider License Number State Code 9: PA
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 2084A0401X
Provider License Number 10: MD443569
Provider License Number State Code 10: PA
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 2084P0802X
Provider License Number 11: MD039704E
Provider License Number State Code 11: PA
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 208M00000X
Provider License Number 12: MD433062
Provider License Number State Code 12: PA
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 208VP0000X
Provider License Number 13: MD042726L
Provider License Number State Code 13: PA
Healthcare Provider Primary Taxonomy Switch 13: N
Healthcare Provider Taxonomy Code 14: 261QR0405X
Healthcare Provider Primary Taxonomy Switch 14: N
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 13: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 7/29/2024