Provider Demographics
NPI:1023421468
Name:ALABAMA EAR, NOSE & THROAT SPECIALISTS, LLC
Entity type:Organization
Organization Name:ALABAMA EAR, NOSE & THROAT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-523-9300
Mailing Address - Street 1:302 MERCHANTS WALK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2290
Mailing Address - Country:US
Mailing Address - Phone:205-523-9300
Mailing Address - Fax:205-523-9301
Practice Address - Street 1:302 MERCHANTS WALK
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2290
Practice Address - Country:US
Practice Address - Phone:205-523-9300
Practice Address - Fax:205-523-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26424207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161536Medicaid
AL161536Medicaid