MEDICARE: AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	1000464101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	528504184	OTHER	UT	PEHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	528504184	OTHER	UT	ALTIUS
4	528504184	OTHER	TX	UNITED MED CHOICE
5	52850418400001	OTHER	UT	BCBS OF UTAH
6	4500045	OTHER	TX	UNITED HEALTH CARE FLEX
7	528504184	OTHER	UT	EDUCATOR MUTUAL
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	190171900	OTHER	KY	US DEPT OF LABOR
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	528504184	OTHER	CA	UNITED MINE WORKERS
13	154998	OTHER	UT	DMBA
14	528504184	OTHER	KY	MAILHANDLERS

General Provider Information

NPI Number	:	1114010717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHARLES REX SCOTT
Credential	:	MS,CCC-A
Telephone Number	:	801-364-8692

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/04/2008

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