Provider Demographics
NPI:1679665848
Name:NORTH RIVER E.N.T., PC
Entity Type:Organization
Organization Name:NORTH RIVER E.N.T., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-9930
Mailing Address - Street 1:1224 MCFARLAND BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406
Mailing Address - Country:US
Mailing Address - Phone:205-759-9930
Mailing Address - Fax:205-759-9931
Practice Address - Street 1:1224 MCFARLAND BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-759-9930
Practice Address - Fax:205-759-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH481Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBERT