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General NPI Number Information
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NPI Number | 1831395912
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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 | 06/25/2007
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 1705 WARREN AVE SUITE 101-103
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-2647
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Country | US
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Telephone | 570-321-2020
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Fax | 570-320-7576
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | PA
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Taxonomy #7
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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 | PA
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Taxonomy #8
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State | PA
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