NPIMap

Organization Active NPI

Susquehanna Physician Services

  • Family Medicine Physician
  • Williamsport, PA
National Provider Identifier
1780603837
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Practice address
2134 W 4TH St
Williamsport, PA 17701-4344
Phone
(570) 321-9009
Fax
(570) 321-6761
NPI assigned
Jul 19, 2006
Last updated
Jan 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X

Addresses

Primary practice location

2134 W 4TH St
Williamsport, PA 17701-4344

Mailing address

1205 Grampian Blvd
PO Box 3127
Williamsport, PA 17701-1978

Other identifiers 1

IdentifierTypeStateIssuer
880576OtherPAHIGHMARK BLUE SHIELD

Other names 1

  • SPS-West End Family Practice Other name

National Provider Directory

National Provider Directory
Tax ID family
SPS Ed26 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

Locations

2134 W 4th St
Williamsport, PA 17701
Phone (570) 321-9009

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200614400000",
    "number": "1780603837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 GRAMPIAN BLVD",
            "address_2": "PO BOX 3127",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2134 W 4TH ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177014344",
            "telephone_number": "570-321-9009",
            "fax_number": "570-321-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-01-18",
        "status": "A",
        "authorized_official_last_name": "SANTANGELO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "880576",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPS-West End Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; 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.