# SUSQUEHANNA PHYSICIAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SPS-Audiology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689680233
- **Authorized official:** MR. CHARLES SANTANGELO (EXECUTIVE VP CFO)
- **Authorized official phone:** (570) 321-3171

## Contact information

- **Practice address:** 1705 WARREN AVE, SUITE 204, WILLIAMSPORT, PA 17701-2647
- **Practice address phone:** (570) 326-8360
- **Practice address fax:** (570) 326-8624
- **Mailing address:** 1205 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-1978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | — | — | Yes |
| 237600000X | Audiologist-Hearing Aid Fitter | — | — | — |

## Other

- **Enumeration date:** 08/01/2006
- **Last updated:** 10/18/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 716011 | HIGHMARK BLUE SHIELD | PA |