Provider Demographics
NPI:1528237922
Name:LISTON INCORPORATED
Entity type:Organization
Organization Name:LISTON INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-626-0620
Mailing Address - Street 1:1259 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:PA
Mailing Address - Zip Code:15431-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1259 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:PA
Practice Address - Zip Code:15431-2305
Practice Address - Country:US
Practice Address - Phone:724-626-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066111Medicare UPIN