Basic Information
| Provider Information | |||||||||
| NPI: | 1689670648 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AUDIOLOGY AND HEARING AID SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AUDIOLOGY AND HEARING AID SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N KEEL RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004718592 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 N KEEL RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004718592 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 12/19/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BALKO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8004718592 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | F03245 | PA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 231H00000X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 1065434 | 01 | WV | WORKERS COMP | OTHER | 1034278 | 01 | PA | GATEWAY | OTHER | 1007407040005 | 05 | PA | MEDICAID | 210962 | 01 | PA | UPMC | OTHER | 891579 | 01 | PA | BLUE CROSS | OTHER |