1528146578 NPI number — WOOSTER ENT ASSOC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528146578 NPI number — WOOSTER ENT ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOOSTER ENT ASSOC
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:
1528146578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14136 GALEHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-658-3104
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1749 CLEVELAND RD
Provider Second Line Business Practice Location Address:
WOOSTER ENT
Provider Business Practice Location Address City Name:
WOOSTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-264-9699
Provider Business Practice Location Address Fax Number:
330-264-9644
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAN
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
330-264-9699

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  A01074 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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