Provider Demographics
NPI:1093195745
Name:RIVERVIEW ORTHOTICS PROSTHETICS INC
Entity Type:Organization
Organization Name:RIVERVIEW ORTHOTICS PROSTHETICS INC
Other - Org Name:SUSQUEHANNA VALLEY PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REG COMPLIANCE SPECIALIST III
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-961-2102
Mailing Address - Street 1:2 ATRIUM CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9019
Mailing Address - Country:US
Mailing Address - Phone:570-743-1414
Mailing Address - Fax:570-743-5215
Practice Address - Street 1:2 ATRIUM CT
Practice Address - Street 2:SUITE B
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9019
Practice Address - Country:US
Practice Address - Phone:570-743-1414
Practice Address - Fax:570-743-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018798690006Medicaid
PA4265110004Medicare NSC