1184776759 NPI number — AUDIOLOGY & HEARING CENTERS OF NEPA, LLC

Table of content: (NPI 1184776759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184776759 NPI number — AUDIOLOGY & HEARING CENTERS OF NEPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY & HEARING CENTERS OF NEPA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184776759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 SPRUCE ST
Provider Second Line Business Mailing Address:
BANK TOWER - 7TH FLOOR
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18503-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-343-7710
Provider Business Mailing Address Fax Number:
570-343-7734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 SPRUCE ST
Provider Second Line Business Practice Location Address:
BANK TOWER - 7TH FLOOR
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18503-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-343-7710
Provider Business Practice Location Address Fax Number:
570-343-7734
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRISLUPSKI
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
AUDIOLOGIST
Authorized Official Telephone Number:
570-343-7710

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  AT000012L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332S00000X , with the licence number: AT000012L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102958262-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007510830004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019075890003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30132 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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