Provider Demographics
NPI:1942368014
Name:SCOTTSBORO ENT, PC
Entity Type:Organization
Organization Name:SCOTTSBORO ENT, PC
Other - Org Name:DEKALB EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-574-6100
Mailing Address - Street 1:406 TAYLOR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2406
Mailing Address - Country:US
Mailing Address - Phone:256-574-6100
Mailing Address - Fax:256-574-3004
Practice Address - Street 1:406 TAYLOR ST STE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2406
Practice Address - Country:US
Practice Address - Phone:256-574-6100
Practice Address - Fax:256-574-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty