Provider Demographics
NPI: | 1275292534 |
---|---|
Name: | FLORIDA ENT ASSOCIATES, INC. |
Entity Type: | Organization |
Organization Name: | FLORIDA ENT ASSOCIATES, INC. |
Other - Org Name: | ORLANDO ENT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CREDENTIALING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ASHLEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HODGKISS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-558-3724 |
Mailing Address - Street 1: | 15280 NW 79TH CT STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMI LAKES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33016-5873 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-558-3724 |
Mailing Address - Fax: | 305-558-4316 |
Practice Address - Street 1: | 5830 LAKE UNDERHILL RD |
Practice Address - Street 2: | |
Practice Address - City: | ORLANDO |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32807-4311 |
Practice Address - Country: | US |
Practice Address - Phone: | 407-658-0228 |
Practice Address - Fax: | 407-282-5483 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-12-14 |
Last Update Date: | 2023-01-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Single Specialty |