Basic Information
| Provider Information | |||||||||
| NPI: | 1649248063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COAST ENT ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3770 JANES RD | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078225020 | ||||||||
| FaxNumber: | 7078221969 | ||||||||
| Practice Location | |||||||||
| Address1: | 3770 JANES RD | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078225020 | ||||||||
| FaxNumber: | 7078221969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 02/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | AVILA | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7078225020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | GR0056090 | 01 | CA | MEDI-CAL | OTHER |