Susquehanna Physician Services

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SUSQUEHANNA PHYSICIAN SERVICES

Practice address

10 Shady LN
Suite 201
Muncy, PA 17756-8807

Phone

(570) 546-4185

Fax

(570) 546-4165

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Melissa Davis

Title

VP/Coo

Phone

(570) 320-7696

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Susquehanna Health General Surgery at Muncy Other name

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1073532107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SHADY LN",
            "address_2": "SUITE 201",
            "city": "MUNCY",
            "state": "PA",
            "postal_code": "177568807",
            "telephone_number": "570-546-4185",
            "fax_number": "570-546-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "570-320-7696",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "888653",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760196",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health General Surgery at Muncy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lisa Marie Stopper-Gee, MPT
• Bethany Lauren Stroup, OTR/L
• Alena Stump, PA-C
• Mollie Elizabeth Sullivan, SLP
• Susquehanna Physician Services
• Susquehanna Physician Services
• Afrah Talpur, MD
• Mark Philip Tarquinio, BS PHARMACY
• Trudy L Temple
• The River Valley Regional Young Men'S Christian Association

• Surgery Physician in Muncy, PA
• Providers in Muncy, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.