Provider Demographics
NPI:1285620740
Name:DESERET AUDIOLOGY & HEARING
Entity type:Organization
Organization Name:DESERET AUDIOLOGY & HEARING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:MCD FAAA
Authorized Official - Phone:435-688-8866
Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:#360
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4508
Mailing Address - Country:US
Mailing Address - Phone:435-688-8866
Mailing Address - Fax:435-688-2882
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:#360
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4508
Practice Address - Country:US
Practice Address - Phone:435-688-8866
Practice Address - Fax:435-688-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty