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
700 HIGH STREET, WILLIAMSPORT, PA 17701-3198
(570) 321-3580
(570) 321-3581
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760181
—
PA
01
—
1927136
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/11/2006
Last updated
11/02/2015
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