Provider Demographics
NPI:1922138445
Name:KEYSTONE HEARING INSTITUTE
Entity Type:Organization
Organization Name:KEYSTONE HEARING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD FAAA
Authorized Official - Phone:717-646-9300
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-646-9300
Mailing Address - Fax:717-646-9322
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-646-9300
Practice Address - Fax:717-646-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001146L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018229820002Medicaid
PA0018229820002Medicaid