Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Orthopaedic Surgery/CRNP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
1705 WARREN AVE, WILLIAMSPORT, PA 17701-2647
(570) 322-0609
(570) 322-4135
Mailing address
PO BOX 3127, 1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760174
—
PA
Enumeration date
08/05/2009
Last updated
08/27/2009
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