Provider Demographics
NPI:1245536101
Name:MSK ENTERPRISE LLC
Entity type:Organization
Organization Name:MSK ENTERPRISE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:801-268-6497
Mailing Address - Street 1:777 E 4500 S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3067
Mailing Address - Country:US
Mailing Address - Phone:801-268-6497
Mailing Address - Fax:801-268-1376
Practice Address - Street 1:777 E 4500 S
Practice Address - Street 2:SUITE 110
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3067
Practice Address - Country:US
Practice Address - Phone:801-268-6497
Practice Address - Fax:801-268-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3243504101261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech