Provider Demographics
NPI:1689770174
Name:SHELBY EAR NOSE AND THROAT
Entity Type:Organization
Organization Name:SHELBY EAR NOSE AND THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-621-8900
Mailing Address - Street 1:1010 1ST ST N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8608
Mailing Address - Country:US
Mailing Address - Phone:205-621-8900
Mailing Address - Fax:205-621-7169
Practice Address - Street 1:1010 1ST ST N
Practice Address - Street 2:SUITE 301
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-621-8900
Practice Address - Fax:205-621-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51008484OtherBCBS OF AL
AL51025753OtherBCBS OF AL
AL1010027OtherUNITED HEALTHCARE
AL2512856002OtherCIGNA
AL51530334OtherBCBS OF AL
ALF51696OtherHEALTHSPRINGS OF ALABAMA
AL=========OtherVIVA
AL2512856002OtherCIGNA
AL1010027OtherUNITED HEALTHCARE