QUEEN CITY EAR NOSE AND THROAT ASSOC INC

Provider Demographics

• NPI: 1437104098
• Name: QUEEN CITY EAR NOSE AND THROAT ASSOC INC
• Entity Type: Organization
• Organization Name: QUEEN CITY EAR NOSE AND THROAT ASSOC INC
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: MARK
• Authorized Official - Middle Name: DAVID
• Authorized Official - Last Name: DEUTSCH
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 513-793-9600
• Mailing Address - Street 1: PO BOX 706187
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45270-0001
• Mailing Address - Country: US
• Mailing Address - Phone: 513-793-9600
• Mailing Address - Fax: 513-793-4928
• Practice Address - Street 1: 11135 MONTGOMERY RD
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45249-2338
• Practice Address - Country: US
• Practice Address - Phone: 513-793-9600
• Practice Address - Fax: 513-793-4928
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-23
• Last Update Date: 2014-01-06

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	0405003	Other	MEDICARE PIN-SGL-MONTGOMERY
OH	0026626	Medicaid
OH	0173039	Medicaid
OH	0240171	Medicaid
OH	0373091	Other	MEDICARE PIN-RM-MONTGOMERY
OH	0802291	Other	MEDICARE PIN -MONTGOMERY-MDD
OH	4064261	Other	MEDICARE PIN-ELS-MONTGOMERY
OH	CJ8475	Other	RR MEDICARE
OH	0802297	Other	MEDICARE PIN-MDD-WILMINGTON
OH	4064262	Other	MEDICARE PIN-ELS-WILMINGTON
OH	0950798	Medicaid
OH	2253181	Medicaid
OH	4064262	Other	MEDICARE PIN-ELS-WILMINGTON
OH	4064261	Other	MEDICARE PIN-ELS-MONTGOMERY
OH	0373091	Other	MEDICARE PIN-RM-MONTGOMERY
OH	0173039	Medicaid
OH	040017069	Medicare PIN
OH	P00061175	Medicare PIN
OH	9284003	Medicare PIN
OH	0950798	Medicaid
OH	0405003	Other	MEDICARE PIN-SGL-MONTGOMERY
OH	2253181	Medicaid