Provider Demographics
NPI:1689043515
Name:ENT CENTERS OF EXCELLENCE
Entity Type:Organization
Organization Name:ENT CENTERS OF EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-1117
Mailing Address - Street 1:1851 N MCKENZIE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4700
Mailing Address - Country:US
Mailing Address - Phone:251-943-1117
Mailing Address - Fax:251-943-1183
Practice Address - Street 1:1851 N MCKENZIE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-4700
Practice Address - Country:US
Practice Address - Phone:251-943-1117
Practice Address - Fax:251-943-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00677553Medicaid
GAA60957Medicare UPIN