Provider Demographics
NPI:1679899777
Name:EAR, NOSE, THROAT CLINIC OF SLIDELL
Entity Type:Organization
Organization Name:EAR, NOSE, THROAT CLINIC OF SLIDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-707-4067
Mailing Address - Street 1:985 ROBERT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2063
Mailing Address - Country:US
Mailing Address - Phone:985-847-1995
Mailing Address - Fax:985-847-1992
Practice Address - Street 1:985 ROBERT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2063
Practice Address - Country:US
Practice Address - Phone:985-847-1995
Practice Address - Fax:985-847-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09276R207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty