Provider Demographics
NPI:1699854745
Name:ENT ASSOCIATES OF SOUTHERN INDIANA, P.C.
Entity Type:Organization
Organization Name:ENT ASSOCIATES OF SOUTHERN INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-332-2226
Mailing Address - Street 1:2920 MCINTYRE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4221
Mailing Address - Country:US
Mailing Address - Phone:812-332-2226
Mailing Address - Fax:812-339-2934
Practice Address - Street 1:2920 MCINTYRE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4221
Practice Address - Country:US
Practice Address - Phone:812-332-2226
Practice Address - Fax:812-339-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50000616A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN549530Medicare ID - Type Unspecified