Organization
MTN CITY PROSTHTICS & ORTHOTICS
Active
Other names
Russell Steadele
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL E STEADELE I CPO (PRESIDENT)
(570) 455-7486
Entity
Organization
Contact information
Practice address
1053 N CHURCH ST, HAZLETON, PA 18202-1447
(570) 455-7486
Mailing address
1053 N CHURCH ST, HAZLETON, PA 18202-1447
(570) 455-7486
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018417720002
—
PA
01
—
215659
PA BLUE SHIELD
PA
01
—
28295
DEMENSION BENEFITS PLAN
PA
01
—
39HA67
CAPITAL BLUE CROSS
PA
01
—
814373
FIRST PRIORITY HEALTH
PA
Enumeration date
04/06/2007
Last updated
12/11/2007
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