OrganizationSusquehanna Physician Services(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address699 Rural Ave, Suite 302, Williamsport, PA 17701-3250(570) 321-3772PECOS 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 ID1871769760Provider TypeOrganizationFull NameSusquehanna Physician ServicesOther Name<Unavail>SubpartNoEnumeration Date5/1/2008Last Updated5/21/2010Contact InformationPractice LocationPractice Address699 Rural Ave, Suite 302, Williamsport, PA 17701-3250Phone(570) 321-3772Fax(570) 321-3773Mailing 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 IssuerProvider IdentifiersIDDescriptionIssuerID0017300760188DescriptionMedicaidIssuerUnlistedPennsylvaniaID2062154DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvania