MEDICARE: PROF. ZACKARY M HALE AU.D

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	A-998	WY
2	231HA2500X	Assistive Technology Supplier Audiologist	AUD-1128	ID
3	231H00000X	Audiologist	AUD-1128	ID

Other Identifiers

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

General Provider Information

NPI Number	:	1861599912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ZACKARY M HALE AU.D

Provider Business Mailing Address
First Line	:	3345 MERLIN DR
Second Line	:	STE 200
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-529-1514
Fax Number	:	208-529-3170

Provider Business Practice Location Address
First Line	:	3345 MERLIN DR
Second Line	:	STE 200
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7405
Country	:	US
Telephone Number	:	208-529-1514
Fax Number	:	208-529-3170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/18/2020

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