Basic Information
| Provider Information | |||||||||
| NPI: | 1477744845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENT ASSOCIATES OF SOUTHERN INDIANA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 MCINTYRE DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123327337 | ||||||||
| FaxNumber: | 8123392934 | ||||||||
| Practice Location | |||||||||
| Address1: | 642 W HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | PAOLI | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474549672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127237459 | ||||||||
| FaxNumber: | 8127237560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 08/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCBRIDE | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8123327337 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.