Provider Demographics
NPI:1811040140
Name:OGDEN AUDIOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:OGDEN AUDIOLOGY SERVICES LLC
Other - Org Name:INTERMOUNTAIN HEARING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARWARD
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-479-3346
Mailing Address - Street 1:5349 S 500 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4736
Mailing Address - Country:US
Mailing Address - Phone:801-479-3346
Mailing Address - Fax:801-479-0725
Practice Address - Street 1:5349 S 500 E
Practice Address - Street 2:SUITE C
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4736
Practice Address - Country:US
Practice Address - Phone:801-479-3346
Practice Address - Fax:801-479-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103819-4101231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111252001Medicaid
WY111252000Medicaid
WY111252000Medicaid
WY111252000Medicaid
WY111252001Medicaid