Provider Demographics
NPI:1689670648
Name:AUDIOLOGY AND HEARING AID SERVICES
Entity Type:Organization
Organization Name:AUDIOLOGY AND HEARING AID SERVICES
Other - Org Name:AUDIOLOGY AND HEARING AID SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-471-8592
Mailing Address - Street 1:100 N KEEL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3440
Mailing Address - Country:US
Mailing Address - Phone:800-471-8592
Mailing Address - Fax:
Practice Address - Street 1:100 N KEEL RIDGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3440
Practice Address - Country:US
Practice Address - Phone:800-471-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA231H00000X
PAF03245332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1065434OtherWORKERS COMP
PA1034278OtherGATEWAY
PA1007407040005Medicaid
PA210962OtherUPMC
PA891579OtherBLUE CROSS
WV1065434OtherWORKERS COMP
PA1007407040005Medicaid