Provider Demographics
NPI:1841301082
Name:ENT ASSOCIATES OF ALABAMA, P.C.
Entity type:Organization
Organization Name:ENT ASSOCIATES OF ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-933-9236
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:POB#3 SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-933-9236
Mailing Address - Fax:205-933-9213
Practice Address - Street 1:833 SAINT VINCENTS DR
Practice Address - Street 2:POB#3 SUITE 402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1606
Practice Address - Country:US
Practice Address - Phone:205-933-9236
Practice Address - Fax:205-933-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060077Medicaid
ALI906Medicare ID - Type UnspecifiedGROUP NUMBER
ALE666Medicare ID - Type UnspecifiedGROUP NUMBER
AL000060077Medicaid