Look up the most recent NPI and PECOS records

Susquehanna Community Health And Dental Clinic, Inc.

Family Medicine

Allopathic & Osteopathic Physicians

471 Hepburn St, Williamsport, PA 17701-6122

PECOS Enrollment

Based on the most recent information from CMS, provider Susquehanna Community Health And Dental Clinic, Inc. does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1831412246
Provider Type
Organization
Full Name
Susquehanna Community Health And Dental Clinic, Inc.

Subpart
No
Enumeration Date
3/12/2010
Last Updated
10/29/2010

Contact Information

Practice Location

471 Hepburn St, Williamsport, PA 17701-6122

(570) 567-5400

(570) 567-5421

Mailing Location

471 Hepburn St, Williamsport, PA 17701-6122

(570) 567-5400

(570) 567-5421

Authorized Official

Krajewski, Ellen M (President/Chief Executive Officer)

(570) 567-5412

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 126800000X	Description Dental Assistant Dental Providers	License Unlisted Issuer
Code 124Q00000X	Description Dental Hygienist Dental Providers	License Unlisted Issuer
Code 122300000X	Description Dentist Dental Providers	License Unlisted Issuer
Code 1223G0001X	Description Dentist Dental Providers	License Unlisted Issuer
Code 1223D0001X	Description Dentist Dental Providers	License Unlisted Issuer

Susquehanna Community Health And Dental Clinic, Inc.

PECOS Enrollment

Profile Details

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