Provider Demographics
NPI:1790008795
Name:MARSHALL HEARING AID SERVICE
Entity Type:Organization
Organization Name:MARSHALL HEARING AID SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING AID FITTER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:FO3085
Authorized Official - Phone:724-376-4310
Mailing Address - Street 1:44 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STONEBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16153-3905
Mailing Address - Country:US
Mailing Address - Phone:724-376-4310
Mailing Address - Fax:724-376-4310
Practice Address - Street 1:44 MAPLE ST
Practice Address - Street 2:
Practice Address - City:STONEBORO
Practice Address - State:PA
Practice Address - Zip Code:16153-3905
Practice Address - Country:US
Practice Address - Phone:724-376-4310
Practice Address - Fax:724-376-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD00759261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000203264OtherHIGHMARK BC/BS