Provider Demographics
NPI:1497880504
Name:ENTEGRITY EAR, NOSE AND THROAT SPECIALISTS, PC
Entity Type:Organization
Organization Name:ENTEGRITY EAR, NOSE AND THROAT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:LAMOINE
Authorized Official - Last Name:SIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-494-5090
Mailing Address - Street 1:6950 E CHAUNCEY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5155
Mailing Address - Country:US
Mailing Address - Phone:602-494-5090
Mailing Address - Fax:602-494-5055
Practice Address - Street 1:6950 E CHAUNCEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5155
Practice Address - Country:US
Practice Address - Phone:602-494-5090
Practice Address - Fax:602-494-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23310Medicaid
AZAZ0875920OtherBLUE CROSS BLUE SHIELD
AZZ103974Medicare PIN