Healthcare Provider Details

I. General information

NPI: 1679748321
Provider Name (Legal Business Name): ROSS AUDIOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 08/15/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN AVE
SCRANTON PA
18504-1720
US

IV. Provider business mailing address

444 N MAIN AVE
SCRANTON PA
18504-1720
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-9970
  • Fax: 570-880-7395
Mailing address:
  • Phone: 570-344-9970
  • Fax: 570-880-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000716L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1020999360001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. SERENA ROSS
Title or Position: AUDIOLOGIST
Credential: AUDIOLOGIST
Phone: 570-489-4581