Provider Demographics
NPI:1114010717
Name:AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOCIATES OF SALT LAKE CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:REX
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-A
Authorized Official - Phone:801-364-8692
Mailing Address - Street 1:508 E SOUTH TEMPLE
Mailing Address - Street 2:STE 203
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1013
Mailing Address - Country:US
Mailing Address - Phone:801-364-8692
Mailing Address - Fax:801-364-0807
Practice Address - Street 1:508 E SOUTH TEMPLE
Practice Address - Street 2:STE 203
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1013
Practice Address - Country:US
Practice Address - Phone:801-364-8692
Practice Address - Fax:801-364-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1000464101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528504184OtherPEHP
UT528504184003Medicaid
UT528504184OtherALTIUS
TX528504184OtherUNITED MED CHOICE
UT52850418400001OtherBCBS OF UTAH
TX4500045OtherUNITED HEALTH CARE FLEX
UT528504184OtherEDUCATOR MUTUAL
UT528504184Medicaid
KY190171900OtherUS DEPT OF LABOR
UTTPRA06318Medicaid
NV100505792Medicaid
CA528504184OtherUNITED MINE WORKERS
UT154998OtherDMBA
KY528504184OtherMAILHANDLERS
UTR79631Medicare UPIN
UT005780801Medicare ID - Type Unspecified
UT528504184Medicaid