Provider Demographics
NPI:1386869626
Name:MEDICAL HEARING CLINIC, INC
Entity type:Organization
Organization Name:MEDICAL HEARING CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-399-5014
Mailing Address - Street 1:3903 HARRISON BLVD
Mailing Address - Street 2:# 201
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2314
Mailing Address - Country:US
Mailing Address - Phone:801-399-5014
Mailing Address - Fax:801-399-0830
Practice Address - Street 1:3903 HARRISON BLVD
Practice Address - Street 2:# 201
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2314
Practice Address - Country:US
Practice Address - Phone:801-399-5014
Practice Address - Fax:801-399-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1596451205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT041157004OtherMEDICARE RR
UT10785OtherDMBA
UT62413OtherMAIL HANDLERS
UT107005980101OtherSELECT CARE
UT107005980101OtherSELECT CARE
UT62413OtherMAIL HANDLERS