OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address904 Campbell St, Suite 202, Williamsport, PA 17701-3165(570) 321-2290PECOS 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 ID1174570618Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date5/30/2006Last Updated7/29/2010Contact InformationPractice LocationPractice Address904 Campbell St, Suite 202, Williamsport, PA 17701-3165Phone(570) 321-2290Fax(570) 321-2289Mailing LocationMailing Address1201 Grampian Blvd, Po Box 3127, Williamsport, PA 17701-0127PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameSantangelo, Charles (Executive Vp/Cfo)Phone(570) 321-3171Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207QA0401XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID0017300760203DescriptionMedicaidIssuerUnlistedPennsylvaniaID880749DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvania