Provider Demographics
NPI:1659715746
Name:MOUNTAINTOP AUDIOLOGY LLC
Entity Type:Organization
Organization Name:MOUNTAINTOP AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:AUD
Authorized Official - Phone:435-688-8991
Mailing Address - Street 1:1054 E. RIVERSIDE DR.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4829
Mailing Address - Country:US
Mailing Address - Phone:435-688-8991
Mailing Address - Fax:435-688-2122
Practice Address - Street 1:415 S. MEDICAL DR.
Practice Address - Street 2:SUITE 202A
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-298-4327
Practice Address - Fax:801-298-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty