OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address2134 W 4th St, Williamsport, PA 17701-4344(570) 321-9009PECOS 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 ID1780603837Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date7/19/2006Last Updated1/18/2008Contact InformationPractice LocationPractice Address2134 W 4th St, Williamsport, PA 17701-4344Phone(570) 321-9009Fax(570) 321-6761Mailing LocationMailing Address1205 Grampian Blvd, Po Box 3127, Williamsport, PA 17701-1978PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameSantangelo, Charles (Executive Vp/Cfo)Phone(570) 321-3171Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207VX0000XDescriptionObstetrics & GynecologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID880576DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvania