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	100046-4101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52850418401001	OTHER	UT	BLUE CROSS BLUE SHIELS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407979479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.

Provider Business Mailing Address
First Line	:	10441 S REDWOOD RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:	801-302-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	10441 S REDWOOD RD
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8502
Country	:	US
Telephone Number	:	801-302-8022
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHARLES REX SCOTT
Credential	:	M.A., CCC-A
Telephone Number	:	801-302-8022

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	09/04/2008

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