SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC (NPI# 1790333292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790333292 |
| Entity Type | Organization |
| Organization Name | SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC |
| Practice Address |
431 Hepburn St Williamsport PA 17701-6122 |
| Mailing Address |
471 Hepburn St Williamsport PA 17701-6122 |
| Practice Telephone | 5705675400 |
| Mailing Telephone | 5705675400 |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2019-08-28 |
| Authorized Official Name | MAX HOUSEKNECHT JR. (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5705675418 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| River Valley Health & Dental Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386106680 | Susquehanna Community Health and Dental Clinic, Inc | Pharmacy | 471 Hepburn St, Williamsport, PA 17701-6122 | 2019-04-04 |
| 1184998361 | Susquehanna Community Health and Dental Clinic, Inc | Clinic/Center | 471 Hepburn St, Williamsport, PA 17701-6122 | 2012-03-06 |
| Street Address |
431 HEPBURN ST |
| City | WILLIAMSPORT |
| State | PA |
| Zip Code | 17701-6122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184267809 | Charlene Angella Pitter | Nurse Practitioner | 170 Warren Ave, Williamsport, PA 17701 | 2019-10-25 |
| 1396395299 | Susan E Fetzer | Occupational Therapy Assistant | Upmc Susquehanna,625 West Edwin Street, Williamsport, PA 17701 | 2019-09-13 |
| 1184280984 | Craig Andrew Tuller | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency, 740 High Street, Suite 4001, Williamsport, PA 17701 | 2019-05-16 |
| 1760048045 | Michael Harvey | Student in an Organized Health Care Education/Training Program | 740 High St. Suite 4001, Williamsport, PA 17701 | 2019-05-13 |
| 1275196008 | Olivia Fladmark | Student in an Organized Health Care Education/Training Program | Williamsport Family Medicine Residency 740 High St, Suite 4001, Williamsport, PA 17701 | 2019-04-17 |
| 1528551231 | Mark Hampton Chiropractic Inc. | Durable Medical Equipment & Medical Supplies | 1111 East 3rd Street, Williamsport, PA 17701 | 2018-06-08 |
| 1548710882 | Central Pennsylvania Rehabilitation Medicine, Inc | Physical Medicine & Rehabilitation | 460 River Ave Ste 1, Williamsport, PA 17701 | 2016-10-11 |
| 1376096784 | Christine Kessler | Physician Assistant | One College Ave, Penna. College of Tech, Pa Program Dif 123, Williamsport, PA 17701 | 2016-08-02 |
| 1629440276 | Matthew Ray Rebuck | Specialist/Technologist | 220 N Reach Rd, Williamsport, PA 17701 | 2015-10-22 |
| 1508237223 | Neihl Williamson | Physician Assistant | 1205 Grampian Blvd Ste 3c, Williamsport, PA 17701 | 2015-10-08 |
| Find all providers in zip 17701 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184998361 | Susquehanna Community Health and Dental Clinic, Inc | Clinic/Center | 471 Hepburn St, Williamsport, PA 17701-6122 | 2012-03-06 |
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|---|---|---|---|---|
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| 1508478157 | Greater Philadelphia Health Action Incorporated | Clinic/Center | 2463 Emerald St, Philadelphia, PA 19125-1236 | 2020-08-17 |
| 1255943809 | Greater Philadelphia Health Action Incorporated | Clinic/Center | 3116 Frankford Ave, Philadelphia, PA 19134-3827 | 2020-08-17 |
| 1467063396 | Greater Philadelphia Health Action Incorporated | Clinic/Center | 1952 E Allegheny Ave, Philadelphia, PA 19134-3122 | 2020-08-13 |
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| 1275151607 | Greater Philadelphia Health Action Incorporated | Clinic/Center | 1717 W Allegheny Ave, Philadelphia, PA 19132-1606 | 2020-07-13 |
| 1538781166 | Hyndman Area Health Center, Inc. | Clinic/Center | 214 College Park Plz Ste 203, Johnstown, PA 15904-2833 | 2020-05-18 |
| 1588285076 | Community Health and Dental Care, Inc | Clinic/Center | 1315 Route 100 North, Barto, PA 19504-8724 | 2020-05-06 |
| 1053946079 | Neighborhood Health Centers of The Lehigh Valley | Clinic/Center | 635 E Broad St, Bethlehem, PA 18018-6332 | 2020-03-10 |
| Find all providers with the same taxonomy | ||||
| City | WILLIAMSPORT |
| Zip Code | 17701 |
Please comment or provide details below to improve the information on SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.