Provider Demographics
NPI:1467687830
Name:RYAN HANSON AU.D., P.C.
Entity Type:Organization
Organization Name:RYAN HANSON AU.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:435-637-3427
Mailing Address - Street 1:945 W HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4230
Mailing Address - Country:US
Mailing Address - Phone:435-637-4327
Mailing Address - Fax:435-613-9709
Practice Address - Street 1:945 W HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4230
Practice Address - Country:US
Practice Address - Phone:435-637-4327
Practice Address - Fax:435-613-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62658454101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52998595001Medicaid