1639114689 NPI number — SUSQUEHANNA PHYSICIAN SERVICES

Table of content: BELINDA JOYCE HART LMT (NPI 1811128515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639114689 NPI number — SUSQUEHANNA PHYSICIAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSQUEHANNA PHYSICIAN SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUSQUEHANNA HEALTH MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639114689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 GRAMPIAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 GRAMPIAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-326-8457
Provider Business Practice Location Address Fax Number:
570-320-7989
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/COO
Authorized Official Telephone Number:
570-320-7696

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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