1023044732 NPI number — ENT GROUP, LLC

Table of content: (NPI 1023044732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023044732 NPI number — ENT GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENT GROUP, 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:
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:
1023044732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL LANE
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-1989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-745-3758
Provider Business Mailing Address Fax Number:
317-745-3749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL LANE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-1989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-745-3758
Provider Business Practice Location Address Fax Number:
317-745-3749
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURRY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
317-745-3758

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000105044 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200309960A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN7773 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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