Provider Demographics
NPI:1326048836
Name:EAR NOSE AND THROAT SPECIALISTS INC
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT SPECIALISTS INC
Other - Org Name:HAMILTON FAIRFIELD ENT SPECIALISTS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:OKUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-874-0990
Mailing Address - Street 1:3145 HAMILTON MASON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8557
Mailing Address - Country:US
Mailing Address - Phone:513-874-0990
Mailing Address - Fax:513-874-0998
Practice Address - Street 1:3145 HAMILTON MASON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8557
Practice Address - Country:US
Practice Address - Phone:513-874-0990
Practice Address - Fax:513-874-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428282Medicaid