Provider Demographics
NPI:1033162185
Name:KEYSTONE HEARING AND AUDIOLOGY INC
Entity Type:Organization
Organization Name:KEYSTONE HEARING AND AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAURORA
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCA
Authorized Official - Phone:724-468-5959
Mailing Address - Street 1:154 ABBE PLACE
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626
Mailing Address - Country:US
Mailing Address - Phone:724-468-5959
Mailing Address - Fax:724-468-5959
Practice Address - Street 1:154 ABBE PLACE
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626
Practice Address - Country:US
Practice Address - Phone:724-468-5959
Practice Address - Fax:724-468-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000525231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058745Medicaid
PA512805OtherHIGHMARK
02683OtherHEARUSA
315178OtherUPMC
56228OtherHEALTH AMERICA
0110580OtherAETNA US HEALTH
315178OtherUPMC
PA058745Medicare ID - Type Unspecified