Provider Demographics
NPI:1588854178
Name:CLINIC FOR EAR NOSE THROAT HEAD & NECK MEDICINE & SURGERY P S
Entity Type:Organization
Organization Name:CLINIC FOR EAR NOSE THROAT HEAD & NECK MEDICINE & SURGERY P S
Other - Org Name:OTOLARYNGOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:I
Authorized Official - Last Name:ABBENHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:509-575-7500
Mailing Address - Street 1:307 S 12TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3100
Mailing Address - Country:US
Mailing Address - Phone:509-575-7500
Mailing Address - Fax:509-575-0333
Practice Address - Street 1:307 S 12TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3100
Practice Address - Country:US
Practice Address - Phone:509-575-7500
Practice Address - Fax:509-575-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB38329Medicare PIN