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Contact Information

SUSQUEHANNA PHYSICIAN SERVICES
1100 GRAMPIAN BLVD
WILLIAMSPORT, PA17701-1909
 Phone: 570-326-8550
 Fax: 570-326-8551
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Undersea and Hyperbaric Medicine

2083P0011X 84 Physician/Preventive Medicine
 

Public Health & General Preventive Medicine

2083P0901X 84 Physician/Preventive Medicine
 

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
 

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for SUSQUEHANNA PHYSICIAN SERVICES

NPI # 1992722524
LBN Legal business name SUSQUEHANNA PHYSICIAN SERVICES
Authorized official MELISSA DAVIS - (VP/COO)
Entity Organization
Organization subpart 1 No
Enumeration date 07/17/2006
Last updated 09/28/2015 - About 11 years ago
Identifiers
PA Medicaid 0017300760199
PA Other 1580634 HIGHMARK BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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