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General NPI Number Information
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NPI Number | 1417141037
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN HEARING CLINICS, INC.
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 1870 N MAIN ST STE 202
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City | CEDAR CITY
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State | UT
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Zip | 84720-7741
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Country | US
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Telephone | 435-867-0714
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Fax | 435-867-0739
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Provider Business Mailing Address
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Address Line | 1870 N MAIN ST STE 202
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City | CEDAR CITY
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State | UT
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Zip | 84720-7744
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Country | US
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Telephone | 435-867-0714
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Fax | 435-867-0739
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC MAXWELL
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Credential | M.S., CCC-A
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Telephone | 435-867-0714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 5256571-4101
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License Number State | UT
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