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NPI Code Detail

MEDICARE: MOUNTAIN WEST HEARING AND SPEECH

MEDICARE: MOUNTAIN WEST HEARING AND SPEECH
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
1237600000XAudiologist-Hearing Aid Fitter104094-4101UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700902376
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN WEST HEARING AND SPEECH
Provider Business Mailing Address
First Line : 777 E 4500 S STE 110
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-3056
Country : US
Telephone Number : 801-268-6497
Fax Number :
Provider Business Practice Location Address
First Line : 777 E 4500 S STE 110
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-3056
Country : US
Telephone Number : 801-268-6497
Fax Number : 801-268-1376
Authorized Official
Title or Position : PRESIDENT
Name : RICHARD S VAN WAGONER
Credential : M.S. CCC-A
Telephone Number : 801-268-6497
Provider Enumeration Date : 03/22/2007
Last Update Date : 08/22/2020

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Directions to “MOUNTAIN WEST HEARING AND SPEECH ” Practice Location

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