Provider Demographics
NPI:1104018878
Name:MONTROSE EARS, NOSE AND THROAT CENTER, L.L.C.
Entity Type:Organization
Organization Name:MONTROSE EARS, NOSE AND THROAT CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-249-3800
Mailing Address - Street 1:231 S NEVADA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4233
Mailing Address - Country:US
Mailing Address - Phone:970-249-3800
Mailing Address - Fax:970-249-3838
Practice Address - Street 1:231 S NEVADA AVE STE A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4233
Practice Address - Country:US
Practice Address - Phone:970-249-3800
Practice Address - Fax:970-249-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPENDING207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39176363Medicaid
CO39176363Medicaid