Organization
LOYALSOCK MOBILITY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN A. RUSSELL (OWNER)
(570) 326-3431
Entity
Organization
Contact information
Practice address
607 PINE ST, WILLIAMSPORT, PA 17701-5014
(570) 326-3431
(570) 505-1389
Mailing address
607 PINE ST, WILLIAMSPORT, PA 17701-5014
(570) 326-3431
(570) 505-1389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026606940001
—
PA
01
—
681906
ADVANTRA FREEDOM
PA
Enumeration date
01/25/2007
Last updated
08/14/2012
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