Provider Demographics
NPI:1497858138
Name:OTOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:OTOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENECKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:314-995-9021
Mailing Address - Street 1:3023 N BALLAS RD
Mailing Address - Street 2:SUITE 675D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2330
Mailing Address - Country:US
Mailing Address - Phone:314-995-9021
Mailing Address - Fax:314-995-9814
Practice Address - Street 1:3023 N BALLAS RD
Practice Address - Street 2:SUITE 675D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2330
Practice Address - Country:US
Practice Address - Phone:314-995-9021
Practice Address - Fax:314-995-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8J88174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001013549Medicare ID - Type Unspecified
MOA37451Medicare UPIN