Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-Audiology
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, SUITE 204, WILLIAMSPORT, PA 17701-2647
(570) 326-8360
(570) 326-8624
Mailing address
1205 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-1978
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
—
—
237600000X
Audiologist-Hearing Aid Fitter
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
716011
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/01/2006
Last updated
10/18/2007
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