1780742296 NPI number — WOOSTER EAR NOSE AND THROAT

Table of content: (NPI 1780742296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780742296 NPI number — WOOSTER EAR NOSE AND THROAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOOSTER EAR NOSE AND THROAT
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:
1780742296
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:
223 WOOSTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44254-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-948-9952
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:
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:
12/05/2006

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 MANAGER
Authorized Official Telephone Number:
330-264-9699

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  A01327 , 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)