Basic Information
| Provider Information | |||||||||
| NPI: | 1194968081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATIONAL SINUS INSTITUTE PLLC | ||||||||
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| OtherOrganizationName: | ENT ASSOCIATES OF LOS ALAMOS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1620 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPANISH FORK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846601008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018222234 | ||||||||
| FaxNumber: | 8558941638 | ||||||||
| Practice Location | |||||||||
| Address1: | 3917 WEST RD | ||||||||
| Address2: | |||||||||
| City: | LOS ALAMOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875442275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5056614147 | ||||||||
| FaxNumber: | 5056614199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2009 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | IRWIN | ||||||||
| AuthorizedOfficialFirstName: | ALEXUS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8018222234 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363A00000X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363L00000X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 355907201 | 05 | TX | MEDICAID | 91584264 | 05 | NM | MEDICAID |