NPIMap

Susquehanna Physician Services

Organization Active NPI Nurse Practitioner · Williamsport, PA

NPI 1891714945 · NPPES record last updated May 26, 2009

Key facts

NPI
1891714945
Entity type
Organization (NPI type 2)
Primary specialty
Nurse Practitioner 363L00000X
Legal business name
SUSQUEHANNA PHYSICIAN SERVICES
Practice address
1100 Grampian Blvd
Williamsport, PA 17701-1909
Phone
(570) 320-7652
Fax
(570) 320-7651
NPI assigned
Jul 19, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 25

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

National Provider Directory

Tax ID family
Susquehanna Phys SVCS (26 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X Yes
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X
Gerontology Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LG0600X
Primary Care Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LP2300X
Clinical Nurse Specialist
Group: 193200000X MULTI-SPECIALTY GROUP		 364S00000X

Addresses

Primary practice location

1100 Grampian Blvd
Williamsport, PA 17701-1909

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
0017300760167MedicaidPA
1665638OtherPAHIGHMARK BLUE SHIELD

Other names

  • SPS-Palliative Care/CRNP Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 26, 2009.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243296000000",
    "number": "1891714945",
    "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": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011909",
            "telephone_number": "570-320-7652",
            "fax_number": "570-320-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA PHYSICIAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2009-05-26",
        "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": "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
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017300760167",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1665638",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPS-Palliative Care/CRNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

All providers in Williamsport, PA · Nurse Practitioner in Pennsylvania

Sources for this page

Verify at the official NPI Registry.