Susquehanna Physician Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUSQUEHANNA PHYSICIAN SERVICES

Doing business as

Susquehanna Health Medical Group

Practice address

215 E Water St
Muncy, PA 17756-8828

Phone

(570) 546-4040

Fax

(570) 546-4095

NPI assigned

Jun 21, 2006

Last updated

Oct 22, 2015By the provider in NPPES

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 2

Addresses

Other identifiers 1

Other names 1

• Susquehanna Health Medical Group Doing business as

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445472000000",
    "number": "1154367035",
    "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": "215 E WATER ST",
            "city": "MUNCY",
            "state": "PA",
            "postal_code": "177568828",
            "telephone_number": "570-546-4040",
            "fax_number": "570-546-4095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2015-10-22",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "804626",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Allan P. Tidwell, PA-C

• Family Medicine Physician in Muncy, PA
• Providers in Muncy, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.