1811980147 NPI number — HUNTINGTON EAR NOSE & THROAT SPECIALISTS LLC

Table of content: (NPI 1811980147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811980147 NPI number — HUNTINGTON EAR NOSE & THROAT SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON EAR NOSE & THROAT SPECIALISTS LLC
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:
RIVER CITIES EAR NOSE AND THROAT SPECIALISTS PLLC
Provider Other Organization Name Type Code:
3
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:
1811980147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 13TH AVENUE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-522-8800
Provider Business Mailing Address Fax Number:
304-523-4303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 13TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-1692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-8800
Provider Business Practice Location Address Fax Number:
304-523-4303
Provider Enumeration Date:
08/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TOUMA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
304-522-8800

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: 65928012 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: N2494 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0010296000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: D5026 . This is a "RR MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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