Provider Demographics
NPI:1982860482
Name:EAR NOSE AND THROAT SPECIALISTS OF ST CLOUD LLC
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT SPECIALISTS OF ST CLOUD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THUONG
Authorized Official - Middle Name:HOAL
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-992-9229
Mailing Address - Street 1:7575 DR. PHILLIPS BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7221
Mailing Address - Country:US
Mailing Address - Phone:407-992-9229
Mailing Address - Fax:877-933-2424
Practice Address - Street 1:7575 DR. PHILLIPS BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7221
Practice Address - Country:US
Practice Address - Phone:407-992-9229
Practice Address - Fax:877-933-2424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR NOSE AND THROAT SPECIALISTS OF ST CLOUD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-04
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10261261QM2500X
FLOS10261261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL488466Medicaid
FL488466Medicaid