Provider Demographics
NPI:1629174834
Name:CENTURY EAR NOSE AND THROAT - HEAD AND NECK SURGERY ASSOCIATES LTD
Entity Type:Organization
Organization Name:CENTURY EAR NOSE AND THROAT - HEAD AND NECK SURGERY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-460-0008
Mailing Address - Street 1:10660 W 143RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1989
Mailing Address - Country:US
Mailing Address - Phone:708-460-4499
Mailing Address - Fax:708-460-8031
Practice Address - Street 1:16001 108TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8788
Practice Address - Country:US
Practice Address - Phone:708-460-0007
Practice Address - Fax:708-460-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01607201OtherBLUE CROSS BLUE SHIELD
ILCM5539OtherPALMETTO RR MEDICARE
IL01607201OtherBLUE CROSS BLUE SHIELD