Provider Demographics
NPI:1417267600
Name:ENT & ALLERGY SPECIALISTS OF SWFL PA
Entity Type:Organization
Organization Name:ENT & ALLERGY SPECIALISTS OF SWFL PA
Other - Org Name:UNIVERSITY EAR, NOSE, AND THROAT ASSOC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-355-2767
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2894
Mailing Address - Country:US
Mailing Address - Phone:941-355-2767
Mailing Address - Fax:941-355-0167
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2894
Practice Address - Country:US
Practice Address - Phone:941-355-2767
Practice Address - Fax:941-355-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251697700Medicaid
DP199AMedicare PIN