Provider Demographics
NPI:1689605016
Name:EAR NOSE AND THROAT ASSOCIATES PC
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-665-0062
Mailing Address - Street 1:2525 FOX RUN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5371
Mailing Address - Country:US
Mailing Address - Phone:605-665-0062
Mailing Address - Fax:605-665-0076
Practice Address - Street 1:2525 FOX RUN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5371
Practice Address - Country:US
Practice Address - Phone:605-665-0062
Practice Address - Fax:605-665-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0462OtherCERT OF REGISTRATION
SD0462OtherCERT OF REGISTRATION
SDS101113Medicare PIN