Provider Demographics
NPI:1528441409
Name:ENT HEARING CENTER LLC
Entity type:Organization
Organization Name:ENT HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-495-4800
Mailing Address - Street 1:8806 S REDWOOD RD
Mailing Address - Street 2:103
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9337
Mailing Address - Country:US
Mailing Address - Phone:801-495-4800
Mailing Address - Fax:801-938-9563
Practice Address - Street 1:756 E 12200 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9724
Practice Address - Country:US
Practice Address - Phone:801-924-2880
Practice Address - Fax:801-938-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6456275-0160261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech