1114010717 NPI number — AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.

Table of content: (NPI 1114010717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114010717 NPI number — AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.
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:
1114010717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 E SOUTH TEMPLE
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-364-8692
Provider Business Mailing Address Fax Number:
801-364-0807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84102-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-364-8692
Provider Business Practice Location Address Fax Number:
801-364-0807
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
REX
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
801-364-8692

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  1000464101 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 528504184 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528504184003 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528504184 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528504184 . This is a "UNITED MED CHOICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 52850418400001 . This is a "BCBS OF UTAH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 4500045 . This is a "UNITED HEALTH CARE FLEX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 528504184 . This is a "EDUCATOR MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528504184 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190171900 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: TPRA06318 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100505792 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528504184 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 154998 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 528504184 . This is a "MAILHANDLERS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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