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Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
Susquehanna Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA DAVIS (VP/COO)
(570) 320-7696
Entity
Organization
Contact information
Practice address
145 SHAFFER ST, SOUTH WILLIAMSPORT, PA 17702-6727
(570) 326-2447
(570) 326-1247
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760153
—
PA
01
—
888650
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/30/2006
Last updated
10/26/2015
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