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General NPI Number Information
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NPI Number | 1922138445
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Entity Type | Organization
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Legal Business Name | KEYSTONE HEARING INSTITUTE
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 250 FAME AVE SUITE 222
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-646-9300
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Fax | 717-646-9322
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Provider Business Mailing Address
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Address Line | 250 FAME AVE SUITE 222
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City | HANOVER
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State | PA
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Zip | 17331-1587
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Country | US
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Telephone | 717-646-9300
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Fax | 717-646-9322
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY WAYNE FOWLER
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Credential | AU.D. FAAA
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Telephone | 717-646-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT001146L
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License Number State | PA
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