Provider Demographics
NPI:1376542316
Name:OHIO ENT SURGEONS, INC.
Entity Type:Organization
Organization Name:OHIO ENT SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:IRENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-2424
Mailing Address - Street 1:974 BETHEL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2467
Mailing Address - Country:US
Mailing Address - Phone:614-538-2424
Mailing Address - Fax:614-538-2418
Practice Address - Street 1:1810 MACKENZIE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2967
Practice Address - Country:US
Practice Address - Phone:614-273-2250
Practice Address - Fax:614-273-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032586207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9923081Medicare PIN