Provider Demographics
NPI:1033369905
Name:HYANNIS EAR, NOSE AND THROAT ASSOC INC
Entity Type:Organization
Organization Name:HYANNIS EAR, NOSE AND THROAT ASSOC INC
Other - Org Name:COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:VANDEMOER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-775-7026
Mailing Address - Street 1:68 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3048
Mailing Address - Country:US
Mailing Address - Phone:508-775-7026
Mailing Address - Fax:508-771-0499
Practice Address - Street 1:68 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3048
Practice Address - Country:US
Practice Address - Phone:508-775-7026
Practice Address - Fax:508-771-0499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HYANNIS EAR, NOSE AND THROAT ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-26
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221071Medicare PIN