| Susquehanna Community Health And Dental Clinic, Inc | |
|
471 Hepburn St Williamsport PA 17701-6122 | |
| (570) 567-5400 | |
| (570) 567-5421 |
| Full Name | Susquehanna Community Health And Dental Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 471 Hepburn St, Williamsport, Pennsylvania |
| Authorized Official Name and Position | James Yoxtheimer (PRESENDENT/CEO) |
| Authorized Official Contact | 5705675414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susquehanna Community Health And Dental Clinic, Inc 471 Hepburn St Williamsport PA 17701-6122 Ph: (570) 567-5400 | Susquehanna Community Health And Dental Clinic, Inc 471 Hepburn St Williamsport PA 17701-6122 Ph: (570) 567-5400 |
| NPI Number | 1184998361 |
|---|---|
| Provider Enumeration Date | 03/06/2012 |
| Last Update Date | 08/26/2019 |
| Medicare PECOS PAC ID | 8527251230 |
|---|---|
| Medicare Enrollment ID | O20120724000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184998361 | NPI | - | NPPES |
| 1024416060001 | Medicaid | PA | |
| 1024416060002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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