Provider Demographics
NPI:1104822253
Name:PENNSYLVANIA EAR INSTITUTE
Entity Type:Organization
Organization Name:PENNSYLVANIA EAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN OF PCO SCHOOL OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-886-8660
Mailing Address - Street 1:8380 OLD YORK RD
Mailing Address - Street 2:STE 120
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1539
Mailing Address - Country:US
Mailing Address - Phone:215-886-8660
Mailing Address - Fax:
Practice Address - Street 1:8380 OLD YORK RD
Practice Address - Street 2:STE 120
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1539
Practice Address - Country:US
Practice Address - Phone:215-886-8660
Practice Address - Fax:215-886-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013771350001Medicaid
PA1013771350002Medicaid
PA1013771350001Medicaid