Provider Demographics
NPI:1407063787
Name:RUSSELL B HEARN & ASSOC
Entity Type:Organization
Organization Name:RUSSELL B HEARN & ASSOC
Other - Org Name:AVADA HEARING AND BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESODENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-282-8491
Mailing Address - Street 1:1022 N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1956
Mailing Address - Country:US
Mailing Address - Phone:724-282-8491
Mailing Address - Fax:724-282-8520
Practice Address - Street 1:1022 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1956
Practice Address - Country:US
Practice Address - Phone:724-282-8491
Practice Address - Fax:724-282-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD0044600332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA202307OtherHIGHMARK BCBS