Provider Demographics
NPI:1487626628
Name:PERRY EAR NOSE AND THROAT CLINIC
Entity Type:Organization
Organization Name:PERRY EAR NOSE AND THROAT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:VOGELGESANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO FOCOO
Authorized Official - Phone:330-837-3359
Mailing Address - Street 1:3545 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-837-3559
Mailing Address - Fax:330-837-3052
Practice Address - Street 1:3545 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646
Practice Address - Country:US
Practice Address - Phone:330-837-3559
Practice Address - Fax:330-837-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001983V207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2250148Medicaid
OHCH2993OtherTRAVELERS RR
OHCH2993OtherTRAVELERS RR