Provider Demographics
NPI:1477502979
Name:INLAND EAR NOSE AND THROAT A MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INLAND EAR NOSE AND THROAT A MEDICAL GROUP INC
Other - Org Name:FOOTHILL AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATEE
Authorized Official - Middle Name:
Authorized Official - Last Name:POOPAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-5859
Mailing Address - Street 1:1030 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-981-5859
Mailing Address - Fax:909-981-8293
Practice Address - Street 1:1030 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 101B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-981-5859
Practice Address - Fax:909-981-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ 387 12 ZMedicare UPIN