SUSQUEHANNA PHYSICIAN SERVICES (NPI# 1033345533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033345533 |
| Entity Type | Organization |
| Organization Name | SUSQUEHANNA PHYSICIAN SERVICES |
| Other Organization Name | SPS-MUNCY IM CRNP |
| Practice Address |
10 Shady Lane Suite 201 Muncy PA 17756-8807 |
| Mailing Address |
1201 Grampian Blvd Po Box 3127 Williamsport PA 17701-0127 |
| Practice Telephone | 5705464100 |
| Practice Fax Number | 5705464101 |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-07-16 |
| Authorized Official Name | MR. CHARLES SANTANGELO (EXECUITVE VP/CFO) |
| Authorized Official Telephone | 5703213171 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0017300760172 | 05 |
| Other Name | Type Code |
|---|---|
| SPS-Muncy IM CRNP | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477793172 | Susquehanna Physician Services | Physician Assistant | 1201 Grampian Blvd Ste 1a, Williamsport, PA 17701-1965 | 2009-02-20 |
| 1780603837 | Susquehanna Physician Services | Obstetrics & Gynecology | 2134 W 4th St, Williamsport, PA 17701-4344 | 2006-07-19 |
| 1083677868 | Susquehanna Physician Services | Internal Medicine | 700 High Street, Williamsport, PA 17701-3198 | 2006-04-11 |
| 1467453878 | Susquehanna Physician Services | Clinic/Center | 1112 Grampian Blvd, Williamsport, PA 17701-1909 | 2005-08-09 |
| 1578164943 | Susquehanna Physician Services | Podiatrist | 2370 Old Turnpike Rd Ste 4, Lewisburg, PA 17837-6567 | 2020-11-03 |
| 1982205472 | Susquehanna Physician Services | Clinic/Center | 416 S Main St Ste 1, Mansfield, PA 16933-1510 | 2020-11-03 |
| 1962018135 | Susquehanna Physician Services | Family Medicine | 700 High St Fl 9, Williamsport, PA 17701-3100 | 2020-09-22 |
| 1992359798 | Susquehanna Physician Services | Emergency Medicine | 700 High St, Williamsport, PA 17701-3100 | 2019-07-30 |
| 1689905606 | Susquehanna Physician Services | Nurse Practitioner | 777 Rural Ave, Williamsport, PA 17701-3109 | 2010-01-15 |
| 1134455967 | Susquehanna Physician Services | Physician Assistant | 1100 Grampian Blvd, Williamsport, PA 17701-1909 | 2009-10-29 |
| Street Address |
10 SHADY LANE SUITE 201 |
| City | MUNCY |
| State | PA |
| Zip Code | 17756-8807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699111229 | Rose A. Trevouledes | Dietitian, Registered | 10 Shady Lane, Suite 202, Muncy, PA 17756 | 2013-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558830653 | Jeff Minor | Pharmacist | 1271 E Penn St, Muncy, PA 17756 | 2018-11-19 |
| 1730661422 | Erika E Mabus Od PC | Optometrist | 2214 Pa-405, Muncy, PA 17756 | 2018-08-30 |
| 1649672833 | Bethany Lauren Stroup | Occupational Therapist | 215 E. Water St., Genesis Rehabilitation Services, Susquehanna Health, Muncy, PA 17756 | 2014-09-19 |
| 1861826430 | Brian D Shiptoski | Nurse Practitioner | 6454 Rt 405 Hwy, Sci-muncy, Muncy, PA 17756 | 2013-08-30 |
| 1770741894 | Families United Network Inc | Foster Care Agency | 276 Ashler Manor Drive, Pennsdale, PA 17756 | 2008-05-27 |
| 1578674826 | Harrison Gooderham Mccormick | Social Worker | 1881 Bitler Hill Road, Muncy, PA 17756 | 2006-08-31 |
| 1316908742 | Anita Nagpal | Physician Assistant | 604 Fox Hollow Circle, Muncy, PA 17756 | 2006-03-28 |
| 1578546685 | Hamptons Chiropractic Inc | Chiropractor | 2848 Route 405 Highway, Muncy, PA 17756 | 2005-11-22 |
| 1083615538 | Melinda A Mckee | Chiropractor | 18 N Washington St, Muncy, PA 17756-1111 | 2005-08-09 |
| 1306833017 | Hallie Ann Shuler | Podiatrist | 144 E Water St, Muncy, PA 17756-1117 | 2005-09-29 |
| Find all providers in zip 17756 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699300954 | Viorica Valentin Velott | Nurse Practitioner | 6454 Route 405 Hwy, Muncy, PA 17756-6388 | 2020-03-06 |
| 1154367035 | Susquehanna Physician Services | Nurse Practitioner | 215 E Water St, Muncy, PA 17756-8828 | 2006-06-21 |
| 1467410340 | Kelly S. Shultz | Nurse Practitioner | 215 E Water St, Susquehanna Health Skilled Nursing & Rehab Center, Muncy, PA 17756-8828 | 2006-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648320 | Jennifer Glace | Nurse Practitioner | 5 Moore Cir, Media, PA 19063-4953 | 2020-10-28 |
| 1710586805 | Tracey Wuestkamp Sloan | Nurse Practitioner | 5218 Bailey Ct W, Doylestown, PA 18902-1477 | 2020-10-20 |
| 1477151280 | Kelly M. Distelrath | Nurse Practitioner | 4203 Timberlane Dr, Allison Park, PA 15101-2954 | 2020-10-14 |
| 1538766837 | Kimberly Ann Martyn | Nurse Practitioner | 168 W Baltimore Pike, Media, PA 19063 | 2020-10-08 |
| 1679170989 | Aubree Marie Richards | Nurse Practitioner | 253 N Hershey Rd Ste 2, Harrisburg, PA 17112-9752 | 2020-10-08 |
| 1326654237 | Alissa Marie Buckanavage | Nurse Practitioner | 6223 Autumn View Dr, Harrisburg, PA 17112-1843 | 2020-09-17 |
| 1508471962 | Macey Schaffer | Nurse Practitioner | 2903 Broadway Ave, Pittsburgh, PA 15234-2801 | 2020-09-12 |
| 1710592472 | Novique Medical Aesthetics | Nurse Practitioner | 1715 S Easton Rd, Doylestown, PA 18901-5923 | 2020-09-10 |
| 1992318141 | Mary Jucel P Angeles | Nurse Practitioner | 100 E Lancaster Ave Ste 467, Wynnewood, PA 19096-3434 | 2020-08-27 |
| 1205448818 | Emily A Lockwood | Nurse Practitioner | 266 Lancaster Ave Ste 303, Malvern, PA 19355-3256 | 2020-08-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.