Healthcare Provider Details

I. General information

NPI: 1417141037
Provider Name (Legal Business Name): INTERMOUNTAIN HEARING CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 N MAIN ST STE 202
CEDAR CITY UT
84720-7741
US

IV. Provider business mailing address

1870 N MAIN ST STE 202
CEDAR CITY UT
84720-7744
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-0714
  • Fax: 435-867-0739
Mailing address:
  • Phone: 435-867-0714
  • Fax: 435-867-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5256571-4101
License Number StateUT

VIII. Authorized Official

Name: ERIC MAXWELL
Title or Position: PRESIDENT
Credential: M.S., CCC-A
Phone: 435-867-0714