NPIMap

Organization Active NPI

Susquehanna Physician Services

  • Nurse Practitioner
  • Muncy, PA
National Provider Identifier
1033345533
Registry record updated Jul 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Practice address
10 Shady Lane
Suite 201
Muncy, PA 17756-8807
Phone
(570) 546-4100
Fax
(570) 546-4101
NPI assigned
Jun 10, 2009
Last updated
Jul 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles Santangelo
Title
Execuitve VP/Cfo
Phone
(570) 321-3171

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

10 Shady Lane
Suite 201
Muncy, PA 17756-8807

Mailing address

1201 Grampian Blvd
PO Box 3127
Williamsport, PA 17701-0127

Other identifiers 1

IdentifierTypeStateIssuer
0017300760172MedicaidPA

Other names 1

  • SPS-Muncy IM CRNP Other name

National Provider Directory

National Provider Directory
Tax ID family
Susquehanna HLTH Fam Med26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1033345533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "address_2": "PO BOX 3127",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177010127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SHADY LANE",
            "address_2": "SUITE 201",
            "city": "MUNCY",
            "state": "PA",
            "postal_code": "177568807",
            "telephone_number": "570-546-4100",
            "fax_number": "570-546-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "SANTANGELO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "EXECUITVE VP/CFO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760172",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPS-Muncy IM CRNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Muncy, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.