Provider Demographics
NPI:1588604896
Name:COMMUNITY EAR NOSE THROAT & ALLERGY,PLLC
Entity Type:Organization
Organization Name:COMMUNITY EAR NOSE THROAT & ALLERGY,PLLC
Other - Org Name:COMMUNITY ENT & ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-425-5556
Mailing Address - Street 1:4950 NORTON HEALTHCARE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2845
Mailing Address - Country:US
Mailing Address - Phone:502-425-5556
Mailing Address - Fax:502-992-0079
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD.
Practice Address - Street 2:SUITE 209
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-425-5556
Practice Address - Fax:502-992-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200830120AMedicaid
KY65945636Medicaid
IN200830120BMedicaid
IN200830120BMedicaid
KY00084Medicare PIN