OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address740 High St, Suite 4001, Williamsport, PA 17701-3100(570) 321-2345PECOS 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 ID1205870904Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date6/15/2006Last Updated10/20/2015Contact InformationPractice LocationPractice Address740 High St, Suite 4001, Williamsport, PA 17701-3100Phone(570) 321-2345Fax(570) 321-2359Mailing LocationMailing Address1201 Grampian Blvd, Williamsport, PA 17701-1900PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameDavis, Melissa (Vp/Coo)Phone(570) 320-7696Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode1041C0700XDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode207V00000XDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID0017300760210DescriptionMedicaidIssuerUnlistedPennsylvaniaID880742DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvaniaID0017300760162DescriptionMedicaidIssuerUnlistedPennsylvania