1699754705 NPI number — E.N.T. AND ALLERGY HEALTH SERVICES, INC.

Table of content: (NPI 1699754705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699754705 NPI number — E.N.T. AND ALLERGY HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E.N.T. AND ALLERGY HEALTH SERVICES, INC.
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:
1699754705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25761 LORAIN RD
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-779-1112
Provider Business Mailing Address Fax Number:
440-779-0247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25761 LORAIN RD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
NORTH OLMSTED
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44070-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-779-1112
Provider Business Practice Location Address Fax Number:
440-779-0247
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BINDER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-779-1112

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2070468 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA1889 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2085514 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085541 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085550 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0972309 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2085523 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: F73001 . This is a "PANUTO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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