Organization Name: | SUSQUEHANNA PHYSICIAN SERVICES |
NPI Number: | 1033345533 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES SANTANGELO (EXECUITVE VP/CFO) |
Mailing Address: | 10 Shady Lane Suite 201 Muncy |
State: | PA US |
Postal Code: | 177568807 |
Phone Number: | 5705464100 |
Fax Number: | 5705464101 |
NPI Enumeration Date: | 06/10/2009 |
NPI Last Update Date: | 07/16/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |