Basic Information
| Provider Information | |||||||||
| NPI: | 1063591212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED HEARING CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1137 EAST 2100 SOUTH | ||||||||
| Address2: | ADVANCED HEARING CENTER INC | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014869309 | ||||||||
| FaxNumber: | 8016062901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1137 EAST 2100 SOUTH | ||||||||
| Address2: | ADVANCED HEARING CENTER INC | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014869309 | ||||||||
| FaxNumber: | 8016062901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 8014869309 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BC-IHIS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 19810817 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 527560877003 | 05 | UT | MEDICAID | 66848C | 01 | UT | DIVISON OF FINANCING | OTHER |