Provider Demographics
NPI:1740511518
Name:BOUNTIFUL HEARING CENTER, PLLC
Entity type:Organization
Organization Name:BOUNTIFUL HEARING CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-A
Authorized Official - Phone:801-295-9644
Mailing Address - Street 1:425 MEDICAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4945
Mailing Address - Country:US
Mailing Address - Phone:801-295-9644
Mailing Address - Fax:801-299-1498
Practice Address - Street 1:425 MEDICAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4945
Practice Address - Country:US
Practice Address - Phone:801-295-9644
Practice Address - Fax:801-299-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1077444101332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528688202012Medicaid
UT000002439Medicare UPIN