Provider Demographics
NPI:1457705717
Name:ADVANCED OTOLARYNGOLOGY & ALLERGY LLC
Entity Type:Organization
Organization Name:ADVANCED OTOLARYNGOLOGY & ALLERGY LLC
Other - Org Name:TARGET HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-5050
Mailing Address - Street 1:864 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1501
Mailing Address - Country:US
Mailing Address - Phone:717-632-5050
Mailing Address - Fax:717-965-7519
Practice Address - Street 1:864 BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1501
Practice Address - Country:US
Practice Address - Phone:717-632-5050
Practice Address - Fax:717-965-7519
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED OTOLARYNGOLOGY & ALLERGY, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care