Provider Demographics
NPI:1811980147
Name:HUNTINGTON EAR NOSE & THROAT SPECIALISTS LLC
Entity type:Organization
Organization Name:HUNTINGTON EAR NOSE & THROAT SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:TOUMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-522-8800
Mailing Address - Street 1:1616 13TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1692
Mailing Address - Country:US
Mailing Address - Phone:304-522-8800
Mailing Address - Fax:304-523-4303
Practice Address - Street 1:1616 13TH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1692
Practice Address - Country:US
Practice Address - Phone:304-522-8800
Practice Address - Fax:304-523-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928012Medicaid
KYN2494OtherRR MEDICARE
WV0010296000Medicaid
WVD5026OtherRR MEDICARE
WVD5026OtherRR MEDICARE
WVHU9289011Medicare PIN
KYCN2494Medicare PIN