Provider Demographics
NPI:1396201323
Name:KEYSTONE AUDIOLOGY & HEARING AIDS, INC.
Entity Type:Organization
Organization Name:KEYSTONE AUDIOLOGY & HEARING AIDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:814-834-7721
Mailing Address - Street 1:1095 MILLION DOLLAR HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2743
Mailing Address - Country:US
Mailing Address - Phone:814-834-7721
Mailing Address - Fax:
Practice Address - Street 1:1095 MILLION DOLLAR HWY STE 2
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2743
Practice Address - Country:US
Practice Address - Phone:814-834-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13968938Medicaid