Healthcare Provider Details

I. General information

NPI: 1740511518
Provider Name (Legal Business Name): BOUNTIFUL HEARING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MEDICAL DR SUITE 200
BOUNTIFUL UT
84010-4945
US

IV. Provider business mailing address

425 MEDICAL DR SUITE 200
BOUNTIFUL UT
84010-4945
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-9644
  • Fax: 801-299-1498
Mailing address:
  • Phone: 801-295-9644
  • Fax: 801-299-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1077444101
License Number StateUT

VIII. Authorized Official

Name: MR. HAROLD R PERGLER
Title or Position: OWNER/AUDIOLOGIST
Credential: MCD, CCC-A
Phone: 801-295-9644