Provider Demographics
NPI:1063628063
Name:HOLLAND & ROBERTSON EAR NOSE & THROAT LLC
Entity Type:Organization
Organization Name:HOLLAND & ROBERTSON EAR NOSE & THROAT LLC
Other - Org Name:HOLLAND & ROBERTSON EAR NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-333-0474
Mailing Address - Street 1:205 SE HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2204
Mailing Address - Country:US
Mailing Address - Phone:918-333-0474
Mailing Address - Fax:918-333-5125
Practice Address - Street 1:205 SE HOWARD AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2204
Practice Address - Country:US
Practice Address - Phone:918-333-0474
Practice Address - Fax:918-333-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15492207Y00000X
OK20308207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111209Medicare PIN
OK100522141Medicare PIN