OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address1205 Grampian Blvd, Suite 3c, Williamsport, PA 17701-1970(570) 320-7800PECOS 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 ID1316975881Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date6/30/2006Last Updated10/20/2015Contact InformationPractice LocationPractice Address1205 Grampian Blvd, Suite 3c, Williamsport, PA 17701-1970Phone(570) 320-7800Fax(570) 320-7801Mailing LocationMailing Address1201 Grampian Blvd, Williamsport, PA 17701-1900PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameDavis, Melissa (Vp/Coo)Phone(570) 320-7696Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207V00000XDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID880365DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvaniaID0017300760158DescriptionMedicaidIssuerUnlistedPennsylvania