Provider Demographics
NPI:1477664514
Name:EAR, NOSE & THROAT ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES, P.C.
Other - Org Name:NORFOLK EAR, NOSE & THROAT, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REBNORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-0062
Mailing Address - Street 1:2525 FOX RUN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5371
Mailing Address - Country:US
Mailing Address - Phone:605-665-0062
Mailing Address - Fax:605-665-0076
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4457
Practice Address - Country:US
Practice Address - Phone:402-844-8110
Practice Address - Fax:402-844-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1216Medicare PIN