Provider Demographics
NPI: | 1831145515 |
---|---|
Name: | SUSQUEHANNA PHYSICIAN SERVICES |
Entity Type: | Organization |
Organization Name: | SUSQUEHANNA PHYSICIAN SERVICES |
Other - Org Name: | SUSQUEHANNA HEALTH MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP/COO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | MELISSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DAVIS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 570-320-7696 |
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: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1201 GRAMPIAN BLVD |
Practice Address - Street 2: | |
Practice Address - City: | WILLIAMSPORT |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17701-1900 |
Practice Address - Country: | US |
Practice Address - Phone: | 570-326-8723 |
Practice Address - Fax: | 570-326-8922 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-25 |
Last Update Date: | 2015-11-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |