OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address1705 Warren Ave, Suite 303, Williamsport, PA 17701-2665(570) 326-8500PECOS EnrollmentBased on the most recent information from CMS, provider Susquehanna Physician Services does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1013963370Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date5/26/2006Last Updated10/20/2015Contact InformationPractice LocationPractice Address1705 Warren Ave, Suite 303, Williamsport, PA 17701-2665Phone(570) 326-8500Fax(570) 326-8049Mailing LocationMailing Address1201 Grampian Blvd, Williamsport, PA 17701-1900PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameDavis, Melissa (Vp/Coo)Phone(570) 320-7696Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207VX0000XDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID0017300760180DescriptionMedicaidIssuerUnlistedPennsylvaniaID802807DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvania