Organization
SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS, INC.
Active
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 T DOMINICK CP (OWNER/ PROSTHETIST)
(570) 743-1414
Entity
Organization
Contact information
Practice address
6850 LOWS RD, SUITE 220, BLOOMSBURG, PA 17815-8729
(570) 387-1711
(570) 387-1766
Mailing address
6850 LOWS RD, SUITE 220, BLOOMSBURG, PA 17815-8729
(570) 387-1711
(570) 387-1766
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
6000007253
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018173000003
—
PA
01
—
116173
HEALTH AMERICA
PA
01
—
1511123
GEISINGER HEALTH PLAN
PA
01
—
2477665
AETNA
PA
01
—
28389
DIMENSIONS
PA
01
—
39HA76
KEYSTONE HEALTH PLAN
PA
01
—
SU206824
HIGHMARK BLUE SHIELD
PA
Enumeration date
09/04/2008
Last updated
09/04/2008
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