Provider Demographics
NPI:1730549775
Name:FAMILY AUDIOLOGY & HEARING SERVICES, INC
Entity type:Organization
Organization Name:FAMILY AUDIOLOGY & HEARING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-787-8440
Mailing Address - Street 1:125 W APPLE BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-9506
Mailing Address - Country:US
Mailing Address - Phone:801-423-1511
Mailing Address - Fax:
Practice Address - Street 1:39 PROFESSIONAL WAY
Practice Address - Street 2:STE 1
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1675
Practice Address - Country:US
Practice Address - Phone:801-465-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107684-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528764883016Medicaid
UT528764883016Medicaid