1114905148 NPI number — THE EAR NOSE AND THROAT SURGICAL ASSOCIATES PA

Table of content: (NPI 1114905148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114905148 NPI number — THE EAR NOSE AND THROAT SURGICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EAR NOSE AND THROAT SURGICAL ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114905148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 BENMORE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-4143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-644-4883
Provider Business Mailing Address Fax Number:
407-644-3697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 BENMORE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-4143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-4883
Provider Business Practice Location Address Fax Number:
407-644-3697
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEHMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-644-4883

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C31310 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CB0799 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24437 . This is a "BC/BS GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 375028100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB0800 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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