Provider Demographics
NPI:1467502534
Name:EWING-EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:EWING-EAR, NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-465-3595
Mailing Address - Street 1:105 GREENBRIAR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9617
Mailing Address - Country:US
Mailing Address - Phone:270-465-3595
Mailing Address - Fax:270-789-2044
Practice Address - Street 1:105 GREENBRIAR DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9617
Practice Address - Country:US
Practice Address - Phone:270-465-3595
Practice Address - Fax:270-789-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29697207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65931966Medicaid
KY000000054088OtherANTHEM BLUE CROSS GROUP
KY65931966Medicaid