| Sps-internal Medicine West Fourth St | |
|
699 Rural Ave Suite 306 Williamsport PA 17701-3246 | |
| (570) 321-3228 | |
| (570) 321-3238 |
| Full Name | Sps-internal Medicine West Fourth St |
|---|---|
| Speciality | Internal Medicine |
| Location | 699 Rural Ave, Williamsport, Pennsylvania |
| Authorized Official Name and Position | Charles Santangelo (EXECUTIVE VP CFO) |
| Authorized Official Contact | 5703213171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sps-internal Medicine West Fourth St 1201 Grampian Blvd Po Box 3127 Williamsport PA 17701-0127 Ph: () - | Sps-internal Medicine West Fourth St 699 Rural Ave Suite 306 Williamsport PA 17701-3246 Ph: (570) 321-3228 |
| NPI Number | 1346428174 |
|---|---|
| Provider Enumeration Date | 02/04/2008 |
| Last Update Date | 12/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346428174 | NPI | - | NPPES |
| 2010019 | Other | PA | HIGHMARK BLUE SHIELD |
| 0017300760166 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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