Provider Demographics
NPI:1477541670
Name:FAMILY EAR NOSE & THROAT CARE
Entity Type:Organization
Organization Name:FAMILY EAR NOSE & THROAT CARE
Other - Org Name:DR LOUIS R CHANIN
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-349-0707
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:60 PHYSICIAN LANE STE 1
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-0011
Mailing Address - Country:US
Mailing Address - Phone:662-349-0707
Mailing Address - Fax:662-349-0708
Practice Address - Street 1:60 PHYSICIANS LN
Practice Address - Street 2:STE 1
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6122
Practice Address - Country:US
Practice Address - Phone:662-349-0707
Practice Address - Fax:662-349-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017484Medicaid
B44917Medicare UPIN
TN3713169Medicare PIN