Basic Information
| Provider Information | |||||||||
| NPI: | 1316990336 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENT SPECIALISTS OF ABILENE, LLP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EAR NOSE & THROAT SPECIALISTS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | 3254371827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 N 18TH ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796012932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254373687 | ||||||||
| FaxNumber: | 3254371827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHANCE | ||||||||
| AuthorizedOfficialFirstName: | JAMI | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3254373608 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CPA, MBA, EFPM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 112878702 | 01 | TX | CIDC | OTHER | 123067 | 01 | TX | SUPERIOR | OTHER | 112878703 | 05 | TX | MEDICAID | 040011721 | 01 | TX | RRMC | OTHER |