Provider Demographics
NPI:1518010651
Name:EAR, NOSE & THROAT OF NATCHEZ
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT OF NATCHEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-8100
Mailing Address - Street 1:PO BOX 18297
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-8297
Mailing Address - Country:US
Mailing Address - Phone:601-445-8100
Mailing Address - Fax:601-445-8600
Practice Address - Street 1:54 SGT PRENTISS DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4726
Practice Address - Country:US
Practice Address - Phone:601-445-8100
Practice Address - Fax:601-445-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19410207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02830380Medicaid
MSC03757Medicare PIN