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General NPI Number Information
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NPI Number | 1841662855
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Entity Type | Organization
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Legal Business Name | KEYSTONE AUDIOLOGY, LLC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 400 BALD HILL RD SUITE 529
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City | WARWICK
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State | RI
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Zip | 02886-1617
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Country | US
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Telephone | 401-595-7318
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Fax |
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Provider Business Mailing Address
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Address Line | 400 BALD HILL RD STE 529
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City | WARWICK
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State | RI
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Zip | 02886-6111
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Country | US
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Telephone | 401-739-4327
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Fax | 401-736-4327
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KRISTEN CONLEY RUBIN
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Credential | AU.D.
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Telephone | 401-739-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | S00061063
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License Number State | RI
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