| Sps-wagner | |
|
531 Broad St Montoursville PA 17754-2338 | |
| (570) 368-2235 | |
| (570) 368-3932 |
| Full Name | Sps-wagner |
|---|---|
| Speciality | Family Medicine |
| Location | 531 Broad St, Montoursville, 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-wagner 1205 Grampian Blvd Po Box 3127 Williamsport PA 17701-1978 Ph: () - | Sps-wagner 531 Broad St Montoursville PA 17754-2338 Ph: (570) 368-2235 |
| NPI Number | 1700805850 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700805850 | NPI | - | NPPES |
| 880690 | Other | PA | HIGHMARK BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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