Provider Demographics
NPI:1861449407
Name:OSU OTOLARYNGOLOGY HEAD AND NECK SURGERY, LLC
Entity Type:Organization
Organization Name:OSU OTOLARYNGOLOGY HEAD AND NECK SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-293-3470
Mailing Address - Street 1:915 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 4000
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-366-3687
Practice Address - Fax:614-293-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOS9357251Medicare PIN
5734140001Medicare NSC