Provider Demographics
NPI:1477519577
Name:ENT AND ALLERGY CLINIC PA
Entity Type:Organization
Organization Name:ENT AND ALLERGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-627-7997
Mailing Address - Street 1:1600 W BUSINESS 380
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3281
Mailing Address - Country:US
Mailing Address - Phone:940-627-7997
Mailing Address - Fax:940-627-7416
Practice Address - Street 1:1600 W BUSINESS 380
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3281
Practice Address - Country:US
Practice Address - Phone:940-627-7997
Practice Address - Fax:940-627-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071LTOtherBCBS
TX1669590Medicaid
TX0071LTOtherBCBS