Provider Demographics
NPI:1720280761
Name:ENT HEARING SERVICES LC
Entity Type:Organization
Organization Name:ENT HEARING SERVICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JERDEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-217-4320
Mailing Address - Street 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:605-217-4320
Mailing Address - Fax:605-217-4320
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:605-217-4320
Practice Address - Fax:605-217-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34004207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty