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
1705 WARREN AVE, SUITE 101-103, WILLIAMSPORT, PA 17701-2647
(570) 321-2020
(570) 320-7576
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
PA
207X00000X
Orthopaedic Surgery Physician
—
PA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
—
PA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
PA
363A00000X
Physician Assistant
—
PA
363AM0700X
Medical Physician Assistant
—
PA
363AS0400X
Surgical Physician Assistant
—
PA
363L00000X
Nurse Practitioner
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760164
—
PA
01
—
1972928
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/25/2007
Last updated
08/18/2016
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