MEDICARE: ERIC L MAXWELL AUD, FAAA

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	5256571-4101	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73269	OTHER	UT	PEHP
2	813571	OTHER	UT	DMBA
3	230742	OTHER	UT	SELECT HEATH
4	52565714100001	OTHER	UT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1871570481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC L MAXWELL AUD, FAAA

Provider Business Mailing Address
First Line	:	1870 N MAIN ST
Second Line	:	SUITE 202
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-7744
Country	:	US
Telephone Number	:	435-867-0714
Fax Number	:	435-867-0739

Provider Business Practice Location Address
First Line	:	1870 N MAIN ST
Second Line	:	SUITE 202
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-7744
Country	:	US
Telephone Number	:	435-867-0714
Fax Number	:	435-867-0739

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	10/09/2023

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