Provider Demographics
NPI:1114936499
Name:GENEVA WOODS EAR, NOSE AND THROAT ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GENEVA WOODS EAR, NOSE AND THROAT ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOGOWITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-563-3515
Mailing Address - Street 1:3730 RHONE CIR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5051
Mailing Address - Country:US
Mailing Address - Phone:907-563-3515
Mailing Address - Fax:
Practice Address - Street 1:3730 RHONE CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5051
Practice Address - Country:US
Practice Address - Phone:907-563-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0000WCHGGMedicare ID - Type UnspecifiedMEDICARE GROUP #
AKC12752Medicare ID - Type UnspecifiedALASKA RAILROAD RETIRE