Provider Demographics
NPI:1396746921
Name:CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC
Entity type:Organization
Organization Name:CLEVELAND EAR NOSE THROAT AND ALLERGY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLEVELAND EAR NOSE THROA
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-662-3711
Mailing Address - Street 1:P.O. BOX 72591
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192
Mailing Address - Country:US
Mailing Address - Phone:216-662-3711
Mailing Address - Fax:216-662-5139
Practice Address - Street 1:5400 TRANSPORTATION BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5324
Practice Address - Country:US
Practice Address - Phone:216-662-3711
Practice Address - Fax:216-662-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149419Medicaid
OHCH5776OtherMEDICARE RAILROAD
OH2149384Medicaid
OH0828886Medicaid
OH2145780Medicaid
OH0675612Medicaid
OH0115619Medicaid
OH2149400Medicaid
OH0419292Medicaid
OH0600415Medicaid
OH0711073Medicaid
OH2149393Medicaid
OH9313144Medicare PIN
OH9313142Medicare PIN
OH2149419Medicaid
OH0419292Medicaid