Provider Demographics
NPI:1982685376
Name:SOUTHERN OHIO ENT ASSOCIATES INC
Entity Type:Organization
Organization Name:SOUTHERN OHIO ENT ASSOCIATES INC
Other - Org Name:MATHEW J COSENZA DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-779-4393
Mailing Address - Street 1:4439 STATE ROUTE 159
Mailing Address - Street 2:STE 100
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8207
Mailing Address - Country:US
Mailing Address - Phone:740-779-4393
Mailing Address - Fax:740-779-4399
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:STE 100
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-4393
Practice Address - Fax:740-779-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000260433OtherANTHEM BLUE CROSS
8179861OtherCIGNA
OH000000260433OtherANTHEM BLUE CROSS