Provider Demographics
NPI:1679644728
Name:ENT ASSOCIATES OF SOUTHEASTERN NEW MEXICO
Entity Type:Organization
Organization Name:ENT ASSOCIATES OF SOUTHEASTERN NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:505-392-0495
Mailing Address - Street 1:PO BOX 2484
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-2484
Mailing Address - Country:US
Mailing Address - Phone:505-392-0495
Mailing Address - Fax:505-392-0562
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9131
Practice Address - Country:US
Practice Address - Phone:505-392-0495
Practice Address - Fax:505-392-0562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0332207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009D16OtherBCBS OF NEW MEXICO
NM20980574Medicaid
NM20980574Medicaid