Susquehanna Physician Services
Organization Active NPI Nuclear Medicine Physician · Williamsport, PA
NPI 1962434076 · NPPES record last updated Nov 16, 2015
Key facts
- NPI
- 1962434076
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nuclear Medicine Physician 207U00000X
- Legal business name
- SUSQUEHANNA PHYSICIAN SERVICES
- Practice address
- 700 High Street
Williamsport, PA 17701-3198 - Phone
- (570) 321-2400
- Fax
- (570) 321-2496
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Melissa Davis
- Title
- VP/Coo
- Phone
- (570) 320-7696
Corporate family (same tax ID) 25
Practitioners 13
-
Ann Marie McGeehan, M.D.
-
Shanteri U Nayak, MD
-
Hassan Tariq, M.D.
-
Danielle M Thompson, CRNP
-
Adwoa Essel, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051103000088 | PA | Part B Supplier - Clinic/Group Practice | 2264336460 |
Receives reassigned benefits from 13 practitioners Practice locations: Mansfield, PA; Williamsport, PA |
National Provider Directory
- Tax ID family
- Susquehanna Phys SVCS
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Medicine Physician |
207U00000X | Yes | ||
| Nuclear Cardiology Physician |
207UN0901X | |||
| Nuclear Radiology Physician |
2085N0904X | |||
| Diagnostic Radiology Physician |
2085R0202X |
Addresses
Primary practice location
700 High Street
Williamsport, PA 17701-3198
Mailing address
1201 Grampian Blvd
Williamsport, PA 17701-1900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 887918 | Other | PA | HIGHMARK BLUE SHIELD |
| 0017300760185 | Medicaid | PA |
Other names
- Susquehanna Health Medical Group
Other providers in Williamsport, PA
- 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 · Nuclear Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.