Provider Demographics
NPI:1528015567
Name:SUSQUEHANNA VENTURES, INC.
Entity Type:Organization
Organization Name:SUSQUEHANNA VENTURES, INC.
Other - Org Name:SUSQUEHANNA HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:570-326-8920
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:570-320-7661
Mailing Address - Fax:570-320-7667
Practice Address - Street 1:1201 GRAMPIAN BLVD
Practice Address - Street 2:DME SUITE
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1900
Practice Address - Country:US
Practice Address - Phone:570-320-7660
Practice Address - Fax:570-320-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413352L332B00000X, 3336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208869OtherHLTH AMERICA / HLTH ASSUR
PA998036OtherBLUE CROSS TRAD.
PA3039097OtherAETNA
PA815786OtherFIRST PRIORITY HEALTH
PA1007515570011Medicaid
PA3956351OtherNCPDP
PA238081OtherACCESS CARE II BLUE CROSS
PA3956351OtherNCPDP