Provider Demographics
NPI:1417141037
Name:INTERMOUNTAIN HEARING CLINICS, INC.
Entity Type:Organization
Organization Name:INTERMOUNTAIN HEARING CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-A
Authorized Official - Phone:435-867-0714
Mailing Address - Street 1:1870 N MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-7744
Mailing Address - Country:US
Mailing Address - Phone:435-867-0714
Mailing Address - Fax:435-867-0739
Practice Address - Street 1:1870 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-7741
Practice Address - Country:US
Practice Address - Phone:435-867-0714
Practice Address - Fax:435-867-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5256571-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT230742OtherSELECT HEALTH
UT73269OtherPEHP
UT52565714100001OtherBLUE CROSS BLUE SHIELD
UT528479103001Medicaid
UT813571OtherDMBA
UT528479103001Medicaid