Provider Demographics
NPI:1154603421
Name:MICHAEL D RAIRIGH,AU.D PLLC
Entity type:Organization
Organization Name:MICHAEL D RAIRIGH,AU.D PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RAIRIGH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:724-347-2005
Mailing Address - Street 1:3135 HIGHLAND RD STE B
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4511
Mailing Address - Country:US
Mailing Address - Phone:724-347-2005
Mailing Address - Fax:724-347-4484
Practice Address - Street 1:3135 HIGHLAND RD STE B
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4511
Practice Address - Country:US
Practice Address - Phone:724-347-2005
Practice Address - Fax:724-347-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006186237600000X, 261QM1300X
PA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230551OtherMEDICARE PTAN