Provider Demographics
NPI:1336326339
Name:OTORHINOLARYNGOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:OTORHINOLARYNGOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-281-6327
Mailing Address - Street 1:6912 WINTON BLOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3555
Mailing Address - Country:US
Mailing Address - Phone:334-281-6327
Mailing Address - Fax:334-284-4537
Practice Address - Street 1:6912 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3555
Practice Address - Country:US
Practice Address - Phone:334-281-6327
Practice Address - Fax:334-284-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012982207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCD2457Medicare UPIN