Provider Demographics
NPI:1245378470
Name:EAR NOSE AND THROAT ASSOCIATES S C
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-361-9199
Mailing Address - Street 1:7350 W COLLEGE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1189
Mailing Address - Country:US
Mailing Address - Phone:708-361-9199
Mailing Address - Fax:708-361-9299
Practice Address - Street 1:7350 W COLLEGE DR STE 208
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1189
Practice Address - Country:US
Practice Address - Phone:708-361-9199
Practice Address - Fax:708-361-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK5680Medicare PIN
209356Medicare PIN