Provider Demographics
NPI:1861448342
Name:ENT MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:ENT MEDICAL SERVICES PC
Other - Org Name:OTOLOGIC MEDICAL SERVICES PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:VINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-351-5680
Mailing Address - Street 1:2615 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9565
Mailing Address - Country:US
Mailing Address - Phone:319-351-5680
Mailing Address - Fax:319-351-8980
Practice Address - Street 1:2615 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9565
Practice Address - Country:US
Practice Address - Phone:319-351-5680
Practice Address - Fax:319-351-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACP7483OtherRR MEDICARE
IA0423459Medicaid
IACP7483OtherRR MEDICARE