Provider Demographics
NPI:1164802815
Name:RIVERVIEW ORTHOTICS PROSTHETICS, INC.
Entity Type:Organization
Organization Name:RIVERVIEW ORTHOTICS PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-899-9247
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:3120 NORTH OLD TRAIL
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9409
Mailing Address - Country:US
Mailing Address - Phone:570-743-1414
Mailing Address - Fax:570-743-5215
Practice Address - Street 1:435 RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3722
Practice Address - Country:US
Practice Address - Phone:570-743-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier