Provider Demographics
NPI:1093910226
Name:HERITAGE EAR , NOSE & THROAT, INC.
Entity Type:Organization
Organization Name:HERITAGE EAR , NOSE & THROAT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-756-2100
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-0261
Mailing Address - Country:US
Mailing Address - Phone:219-476-0352
Mailing Address - Fax:219-531-0859
Practice Address - Street 1:1651 THORNAPPLE CIR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-5496
Practice Address - Country:US
Practice Address - Phone:219-462-9937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091423OtherANTHEM BC/BS
IN100209930AMedicaid
INCD4661Medicare PIN
IN659520Medicare PIN