Provider Demographics
NPI:1063591212
Name:ADVANCED HEARING CENTER INC
Entity type:Organization
Organization Name:ADVANCED HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:BC-IHIS
Authorized Official - Phone:801-486-9309
Mailing Address - Street 1:1137 EAST 2100 SOUTH
Mailing Address - Street 2:ADVANCED HEARING CENTER INC
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-486-9309
Mailing Address - Fax:801-606-2901
Practice Address - Street 1:1137 EAST 2100 SOUTH
Practice Address - Street 2:ADVANCED HEARING CENTER INC
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-486-9309
Practice Address - Fax:801-606-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT19810817231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT527560877003Medicaid
UT66848COtherDIVISON OF FINANCING
UT66848COtherDIVISON OF FINANCING