Provider Demographics
NPI:1477744845
Name:ENT ASSOCIATES OF SOUTHERN INDIANA, P.C.
Entity Type:Organization
Organization Name:ENT ASSOCIATES OF SOUTHERN INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-332-7337
Mailing Address - Street 1:2920 MCINTYRE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4221
Mailing Address - Country:US
Mailing Address - Phone:812-332-7337
Mailing Address - Fax:812-339-2934
Practice Address - Street 1:642 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-9672
Practice Address - Country:US
Practice Address - Phone:812-723-7459
Practice Address - Fax:812-723-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH15715Medicare UPIN