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NPI Code Detail

MEDICARE: SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS, INC.

MEDICARE: SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335E00000XProsthetic/Orthotic Supplier6000007083PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12477665OTHERPAAETNA
2340622OTHERPAHEALTH AMERICA
357492OTHERPAGEISINGER HEALTH PLAN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
528389OTHERPADIMENSIONS
61511123OTHERPAGATEWAY
739HA76OTHERPACAPITAL BLUE CROSS

General Provider Information

NPI Number : 1659557734
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS, INC.
Provider Business Mailing Address
First Line : PO BOX 243
Second Line :
City : SHAMOKIN DAM
State : PA
Zip : 17876-0243
Country : US
Telephone Number : 570-743-1414
Fax Number :
Provider Business Practice Location Address
First Line : 550 W COLLEGE AVE
Second Line : SUITE A
City : PLEASANT GAP
State : PA
Zip : 16823-7401
Country : US
Telephone Number : 814-359-1244
Fax Number : 814-359-1232
Authorized Official
Title or Position : OWNER
Name : MR. FRANK DOMINICK III
Credential : CP
Telephone Number : 570-743-1414
Provider Enumeration Date : 01/18/2008
Last Update Date : 02/12/2009

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