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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Wagner
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
531 BROAD ST, MONTOURSVILLE, PA 17754-2338
(570) 368-2235
(570) 368-3932
Mailing address
1205 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-1978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
880690
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/19/2006
Last updated
08/22/2020
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