Healthcare Provider Details

I. General information

NPI: 1801427752
Provider Name (Legal Business Name): HEGEMONY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 S MAIN ST
WASHINGTON PA
15301-4950
US

IV. Provider business mailing address

182 S MAIN ST
WASHINGTON PA
15301-4950
US

V. Phone/Fax

Practice location:
  • Phone: 724-906-4848
  • Fax: 724-909-1716
Mailing address:
  • Phone: 724-906-4848
  • Fax: 724-909-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WILLIAMSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 530-300-1438