Provider Demographics
NPI:1124150040
Name:TIMPANOGOS AUDIOLOGY, INC.
Entity type:Organization
Organization Name:TIMPANOGOS AUDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-763-0724
Mailing Address - Street 1:321 E 300 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1790
Mailing Address - Country:US
Mailing Address - Phone:801-763-0724
Mailing Address - Fax:801-763-8282
Practice Address - Street 1:321 E 300 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1790
Practice Address - Country:US
Practice Address - Phone:801-763-0724
Practice Address - Fax:801-763-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4769160-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057388Medicare ID - Type Unspecified