Organization
SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC
Active
Parent organization
SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS INC
Authorized official
MR. FRANK THOMAS DOMINICK III CP (OWNER CERTIFIED PROSTHETIST)
(570) 743-1414
Entity
Organization
Contact information
Practice address
3120 N OLD TRAIL, SHAMOKIN DAM, PA 17876
(570) 743-1414
(570) 743-5215
Mailing address
PO BOX 243, SHAMOKIN DAM, PA 17876
(570) 743-1414
(570) 743-5215
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018173000003
—
PA
01
—
116173
HEALTH AMERICA
—
01
—
1511123
GATEWAY
PA
01
—
2477665
AETNA
PA
01
—
28389
ABP ADMINISTRATION
PA
01
—
340622
HEALTH AMERICA
PA
01
—
39HA76
CAPITAL BLUE CROSS
PA
01
—
39HA76
KEYSTONE HEALTH PLAN
—
01
—
57492
GEISINGER HEALTH PLAN
PA
01
—
SU206824
HIGHMARK BLUE SHIELD
PA
01
—
SU206824
BLUE SHIELD
—
Enumeration date
09/13/2005
Last updated
01/03/2008
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