Provider Demographics
NPI:1659497444
Name:FAMILY EAR, NOSE & THROAT, LLC
Entity Type:Organization
Organization Name:FAMILY EAR, NOSE & THROAT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-351-3525
Mailing Address - Street 1:35 WALKER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1727
Mailing Address - Country:US
Mailing Address - Phone:207-351-3525
Mailing Address - Fax:207-351-3524
Practice Address - Street 1:35 WALKER ST STE 200
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1727
Practice Address - Country:US
Practice Address - Phone:207-351-3525
Practice Address - Fax:207-351-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015457207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212278Medicaid
NH30212278Medicaid