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Organization

SUSQUEHANNA PHYSICIAN SERVICES

Active
Other names
SPS-Neurology
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization

Contact information

Practice address
700 HIGH STREET, WILLIAMSPORT, PA 17701-3198
(570) 321-2820
(570) 321-2821
Mailing address
PO BOX 3127, 1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-0127

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017300760176
PA
01
1603595
HIGHMARK BLUE SHIELD
PA
01
50054352
CAPITAL BLUECROSS
PA
Enumeration date
07/07/2006
Last updated
02/22/2012
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