Provider Demographics
NPI:1689772287
Name:EAR NOSE & THROAT MEDICINE AND SURGERY GROUP, LLC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT MEDICINE AND SURGERY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-849-4448
Mailing Address - Street 1:850 AQUIDNECK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7244
Mailing Address - Country:US
Mailing Address - Phone:401-849-4448
Mailing Address - Fax:401-849-6479
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7244
Practice Address - Country:US
Practice Address - Phone:401-849-4448
Practice Address - Fax:401-849-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI739270OtherTUFTS
RIEN11261Medicaid
RI9000136Medicaid
RI0334OtherNEIGHBORHOOD HEALTH PLAN
RICA0758OtherRAILROAD MEDICARE
RI0000002519OtherBLUE CROSS BLUE SHIELD
RI739270OtherTUFTS
RI9000136Medicaid