Provider Demographics
NPI:1114032984
Name:TRINITY EAR NOSE & THROAT PC
Entity Type:Organization
Organization Name:TRINITY EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DOBLE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:208-734-4555
Mailing Address - Street 1:141 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5451
Mailing Address - Country:US
Mailing Address - Phone:208-734-4555
Mailing Address - Fax:208-734-3632
Practice Address - Street 1:141 MORRISON ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5451
Practice Address - Country:US
Practice Address - Phone:208-734-4555
Practice Address - Fax:208-734-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002575200Medicaid
IDCT0334OtherRAILROAD MEDICARE GROUP #
ID000010006553OtherBS GROUP #
ID89292OtherBC GROUP #
ID002574900Medicaid
ID000010006553OtherBS GROUP #