Provider Demographics
NPI:1770885931
Name:ENT ASSOCIATES PLLC
Entity type:Organization
Organization Name:ENT ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-736-9300
Mailing Address - Street 1:1201 S DOUGLAS BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5239
Mailing Address - Country:US
Mailing Address - Phone:405-736-9300
Mailing Address - Fax:405-736-9301
Practice Address - Street 1:1201 S DOUGLAS BLVD
Practice Address - Street 2:STE L
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5239
Practice Address - Country:US
Practice Address - Phone:405-736-9300
Practice Address - Fax:405-736-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4473207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200105030AMedicaid
I73347Medicare UPIN
OK200105030AMedicaid