Healthcare Provider Details

I. General information

NPI: 1528015567
Provider Name (Legal Business Name): SUSQUEHANNA VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GRAMPIAN BLVD DME SUITE
WILLIAMSPORT PA
17701-1900
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-320-7660
  • Fax: 570-320-7659
Mailing address:
  • Phone: 570-320-7661
  • Fax: 570-320-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPP413352L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP413352L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP413352L
License Number StatePA

VIII. Authorized Official

Name: MS. PATRICIA A MCGEE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: MSN
Phone: 570-326-8920