Provider Demographics
NPI:1740530427
Name:ENT ASSOCIATES OF NORTHEAST LOUISIANA, LLC
Entity type:Organization
Organization Name:ENT ASSOCIATES OF NORTHEAST LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-855-6282
Mailing Address - Street 1:2802 KILPATRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5139
Mailing Address - Country:US
Mailing Address - Phone:318-855-6282
Mailing Address - Fax:
Practice Address - Street 1:2802 KILPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5139
Practice Address - Country:US
Practice Address - Phone:318-855-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty