1932194271 NPI number — SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC

Table of content: (NPI 1932194271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932194271 NPI number — SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS 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:
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:
1932194271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 243
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAMOKIN DAM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-743-1414
Provider Business Mailing Address Fax Number:
570-743-5215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3120 N OLD TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAMOKIN DAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-1414
Provider Business Practice Location Address Fax Number:
570-743-5215
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DOMINICK
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER CERTIFIED PROSTHETIST
Authorized Official Telephone Number:
570-743-1414

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116173 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: SU206824 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2477665 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 340622 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39HA76 . This is a "KEYSTONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: SU206824 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018173000003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1511123 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 28389 . This is a "ABP ADMINISTRATION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39HA76 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 57492 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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