1528015567 NPI number — SUSQUEHANNA VENTURES, INC.

Table of content: (NPI 1528015567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528015567 NPI number — SUSQUEHANNA VENTURES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSQUEHANNA VENTURES, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1528015567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2011
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:
570-320-7661
Provider Business Mailing Address Fax Number:
570-320-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 GRAMPIAN BLVD
Provider Second Line Business Practice Location Address:
DME SUITE
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-320-7660
Provider Business Practice Location Address Fax Number:
570-320-7659
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGEE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
570-326-8920

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PP413352L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X , with the licence number: PP413352L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PP413352L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 208869 . This is a "HLTH AMERICA / HLTH ASSUR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 998036 . This is a "BLUE CROSS TRAD." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3039097 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 815786 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007515570011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3956351 . This is a "NCPDP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 238081 . This is a "ACCESS CARE II BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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