MEDICARE: AUDIOLOGY AND HEARING AID SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	F03245	PA
2	231H00000X	Audiologist		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1065434	OTHER	WV	WORKERS COMP
2	1034278	OTHER	PA	GATEWAY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	210962	OTHER	PA	UPMC
5	891579	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1689670648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY AND HEARING AID SERVICES

Provider Business Mailing Address
First Line	:	100 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	800-471-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	800-471-8592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN BALKO
Credential	:
Telephone Number	:	800-471-8592

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/19/2007

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