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General NPI Number Information
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NPI Number | 1083677868
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA PHYSICIAN SERVICES
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 700 HIGH STREET
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3198
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Country | US
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Telephone | 570-321-3580
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Fax | 570-321-3581
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP/COO
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Name | MS. MELISSA DAVIS
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Credential |
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Telephone | 570-320-7696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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