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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Peck Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
904 CAMPBELL ST, SUITE 202, WILLIAMSPORT, PA 17701-3165
(570) 321-2290
(570) 321-2289
Mailing address
1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760203
—
PA
01
—
880749
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/30/2006
Last updated
07/29/2010
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