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General NPI Number Information
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NPI Number | 1578627626
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VALLEY FOOT AND ANKLE CENTER, INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 3120 N OLD TRL STE A
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9428
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Country | US
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Telephone | 570-374-3668
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Fax | 570-374-7306
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Provider Business Mailing Address
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Address Line | 3120 N OLD TRL STE A
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9428
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Country | US
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Telephone | 570-374-3668
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Fax | 570-374-7306
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Authorized Official
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Title or Position | PHYSICIAN, PRESIDENT
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Name | DARLA R MILLER
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Credential | DPM
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Telephone | 570-374-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC004206R
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC004004L
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License Number State | PA
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