Provider Demographics
NPI:1912126459
Name:WIEST AUDIOLOGY AND PROFESSIONAL HEARING AID SERVICE INC
Entity Type:Organization
Organization Name:WIEST AUDIOLOGY AND PROFESSIONAL HEARING AID SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCCA
Authorized Official - Phone:724-283-3984
Mailing Address - Street 1:208 POINT PLAZA
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-283-3984
Mailing Address - Fax:724-283-3796
Practice Address - Street 1:208 POINT PLAZA
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-283-3984
Practice Address - Fax:724-283-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000515L237600000X
PAD00608237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA323484OtherUPMC
PA01946676Medicaid
PA01946676Medicaid
PA323484OtherUPMC