Provider Demographics
NPI:1033162706
Name:ENT CLINIC OF IOWA, PC
Entity Type:Organization
Organization Name:ENT CLINIC OF IOWA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENT CLINIC OF IA
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOISINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:515-267-1800
Mailing Address - Street 1:2600 WESTOWN PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7306
Mailing Address - Country:US
Mailing Address - Phone:515-267-1800
Mailing Address - Fax:515-267-8857
Practice Address - Street 1:2600 WESTOWN PKWY STE 360
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7306
Practice Address - Country:US
Practice Address - Phone:515-267-1800
Practice Address - Fax:515-267-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190967Medicaid
IA49532OtherBCBS GROUP NUMBER
IA0190967Medicaid