Provider Demographics
NPI:1437394657
Name:ACADEMY EAR NOSE THROAT /ALLERGY CLINIC
Entity Type:Organization
Organization Name:ACADEMY EAR NOSE THROAT /ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEARING INSTRUMENT SPECIALISTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:DELAINE
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:BS BC-HIS
Authorized Official - Phone:719-591-2444
Mailing Address - Street 1:2105 ACADEMY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1663
Mailing Address - Country:US
Mailing Address - Phone:719-591-2444
Mailing Address - Fax:719-591-2484
Practice Address - Street 1:2105 ACADEMY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1663
Practice Address - Country:US
Practice Address - Phone:719-591-2444
Practice Address - Fax:719-591-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty