Provider Demographics
NPI:1437457603
Name:INTERMOUNTAIN AUDIOLOGY INC.
Entity Type:Organization
Organization Name:INTERMOUNTAIN AUDIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANWARING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:435-688-2456
Mailing Address - Street 1:515 E 300 S
Mailing Address - Street 2:109
Mailing Address - City:ST.GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3931
Mailing Address - Country:US
Mailing Address - Phone:435-688-2456
Mailing Address - Fax:435-986-4096
Practice Address - Street 1:515 E 300 S
Practice Address - Street 2:STE 109
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3931
Practice Address - Country:US
Practice Address - Phone:435-688-2456
Practice Address - Fax:435-986-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263454-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty