Organization
INTERMOUNTAIN HEARING CLINICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC MAXWELL M.S., CCC-A (PRESIDENT)
(435) 867-0714
Entity
Organization
Contact information
Practice address
1870 N MAIN ST STE 202, CEDAR CITY, UT 84720-7741
(435) 867-0714
(435) 867-0739
Mailing address
1870 N MAIN ST, STE 202, CEDAR CITY, UT 84720-7744
(435) 867-0714
(435) 867-0739
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5256571-4101
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230742
SELECT HEALTH
UT
01
—
52565714100001
BLUE CROSS BLUE SHIELD
UT
05
—
528479103001
—
UT
01
—
73269
PEHP
UT
01
—
813571
DMBA
UT
Enumeration date
08/28/2007
Last updated
10/17/2007
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