# SUSQUEHANNA PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SPS-Orthopaedic Surgery/CRNP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154552347
- **Authorized official:** MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
- **Authorized official phone:** (570) 321-3171

## Contact information

- **Practice address:** 1705 WARREN AVE, WILLIAMSPORT, PA 17701-2647
- **Practice address phone:** (570) 322-0609
- **Practice address fax:** (570) 322-4135
- **Mailing address:** PO BOX 3127, 1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-0127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2009
- **Last updated:** 08/27/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0017300760174 | — | PA |