Provider Demographics
NPI:1699022137
Name:CHRISTIAN EAR NOSE THROAT
Entity Type:Organization
Organization Name:CHRISTIAN EAR NOSE THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-885-5525
Mailing Address - Street 1:1830 HIGH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1746
Mailing Address - Country:US
Mailing Address - Phone:270-885-5525
Mailing Address - Fax:270-885-1811
Practice Address - Street 1:1830 HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1746
Practice Address - Country:US
Practice Address - Phone:270-885-5525
Practice Address - Fax:270-885-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03508207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty