Provider Demographics
NPI:1033381504
Name:LIMA EAR NOSE AND THROAT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:LIMA EAR NOSE AND THROAT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGERS
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-224-5111
Mailing Address - Street 1:770 W HIGH ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3990
Mailing Address - Country:US
Mailing Address - Phone:419-224-5111
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:SUITE 460
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3990
Practice Address - Country:US
Practice Address - Phone:419-224-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084101207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488259Medicaid
OH2488259Medicaid