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
1	335E00000X	Prosthetic/Orthotic Supplier		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116173	OTHER		HEALTH AMERICA
2	SU206824	OTHER		BLUE SHIELD
3	2477665	OTHER	PA	AETNA
4	340622	OTHER	PA	HEALTH AMERICA
5	39HA76	OTHER		KEYSTONE HEALTH PLAN
6	SU206824	OTHER	PA	HIGHMARK BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1511123	OTHER	PA	GATEWAY
9	28389	OTHER	PA	ABP ADMINISTRATION
10	39HA76	OTHER	PA	CAPITAL BLUE CROSS
11	57492	OTHER	PA	GEISINGER HEALTH PLAN

General Provider Information

NPI Number	:	1932194271
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
Country	:	US
Telephone Number	:	570-743-1414
Fax Number	:	570-743-5215

Provider Business Practice Location Address
First Line	:	3120 N OLD TRAIL
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876
Country	:	US
Telephone Number	:	570-743-1414
Fax Number	:	570-743-5215

Authorized Official
Title or Position	:	OWNER CERTIFIED PROSTHETIST
Name	:	MR. FRANK THOMAS DOMINICK III
Credential	:	CP
Telephone Number	:	570-743-1414

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	01/03/2008

Similar Medicare Providers

1891781118 — DRS MUNIR & SAMAD
Practice Location Address:

99 BALDWIN BLVD
SHAMOKIN DAM, PA
17876

Practice Phone: 570-743-7657
Practice Fax: 570-743-0047

1194709493 — DR. ANGELINA MARIE COLTON-SLOTTER DPM
Practice Location Address:

3120 N OLD TRL STE A
SHAMOKIN DAM, PA
17876-9428

Practice Phone: 570-374-3668
Practice Fax: 570-374-7306

1427032382 — DR. DARLA R MILLER DPM
Practice Location Address:

3120 N OLD TRL STE A
SHAMOKIN DAM, PA
17876-9428

Practice Phone: 570-374-3668
Practice Fax: 570-374-7306

1508805615 — SALLY JO FERGUSON-AVERY MD
Practice Location Address:

3057 N SUSQUEHANNA TRL
SHAMOKIN DAM, PA
17876-9114

Practice Phone: 570-743-1112
Practice Fax: 570-743-1114

1962516997 — MOHAMMAD ABDUL SAMAD MD
Practice Location Address:

99 BALDWIN BLVD
SHAMOKIN DAM, PA
17876

Practice Phone: 570-743-7657
Practice Fax: 570-743-0047

1578671079 — DR. JOHN G LAZUR JR. DDS
Practice Location Address:

2 BALDWIN BLVD.
SHAMOKIN DAM, PA
17876

Practice Phone: 570-743-3300
Practice Fax: 570-743-7555

Directions to “SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.