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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Internal Medicine West Fourth St
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
699 RURAL AVE, SUITE 306, WILLIAMSPORT, PA 17701-3246
(570) 321-3228
(570) 321-3238
Mailing address
1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760166
—
PA
01
—
2010019
HIGHMARK BLUE SHIELD
PA
Enumeration date
02/04/2008
Last updated
12/15/2010
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