Healthcare Provider Details

I. General information

NPI: 1053501965
Provider Name (Legal Business Name): CUSTOM HEARING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 SOUTH 5063 WEST
WEST VALLEY UT
84120
US

IV. Provider business mailing address

3285 SOUTH 5063 WEST
WEST VALLEY UT
84120
US

V. Phone/Fax

Practice location:
  • Phone: 801-965-0250
  • Fax:
Mailing address:
  • Phone: 801-965-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number112
License Number StateWY

VIII. Authorized Official

Name: JAMES LYNN JEPHSON
Title or Position: CEO
Credential: BC HIS
Phone: 801-965-0250