Basic Information
| Provider Information | |||||||||
| NPI: | 1679729396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDERSON ENT, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7691 FIVE MILE RD. | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136246127 | ||||||||
| FaxNumber: | 5136246142 | ||||||||
| Practice Location | |||||||||
| Address1: | 7691 FIVE MILE RD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452304348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136246127 | ||||||||
| FaxNumber: | 5136246142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHAINOST | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5136246127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 350 60254 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 0814560 | 05 | OH | MEDICAID |