Susquehanna Physician Services

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SUSQUEHANNA PHYSICIAN SERVICES

Practice address

699 Rural Ave
Suite 302
Williamsport, PA 17701-3250

Phone

(570) 321-3772

Fax

(570) 321-3773

NPI assigned

May 1, 2008

Organization subpart

No

Name

Mr. Charles Santangelo

Title

Executive VP Cfo

Phone

(570) 321-3171

• SPS-Empire Family Medicine Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 21, 2010.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274400000000",
    "number": "1871769760",
    "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": "699 RURAL AVE",
            "address_2": "SUITE 302",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013250",
            "telephone_number": "570-321-3772",
            "fax_number": "570-321-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2010-05-21",
        "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760188",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "2062154",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPS-Empire Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services
• Susquehanna Physician Services

• All providers in Williamsport, PA
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; 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.