1336106624 NPI number — HEATHER M HRUTKAY AUD

Table of content: HEATHER M HRUTKAY AUD (NPI 1336106624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336106624 NPI number — HEATHER M HRUTKAY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HRUTKAY
Provider First Name:
HEATHER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GASPAROVIC
Provider Other First Name:
HEATHER
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336106624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
942 ROYAL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-344-3014
Provider Business Mailing Address Fax Number:
724-663-5360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
942 ROYAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANONSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-344-3014
Provider Business Practice Location Address Fax Number:
724-663-5360
Provider Enumeration Date:
04/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  AT001016L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NECP04646 . This is a "AUDIOLOGY AND HEARING AID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".