Basic Information
| Provider Information | |||||||||
| NPI: | 1871692996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENT PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 ISAAC STREETS DR | ||||||||
| Address2: | SUITE 137 | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196984505 | ||||||||
| FaxNumber: | 4196983806 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 ISAAC STREETS DR | ||||||||
| Address2: | 137 | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196984505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | ADAPPA | ||||||||
| AuthorizedOfficialFirstName: | VIJAY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4196984505 | ||||||||
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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 | 35044940 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 2281892 | 05 | OH | MEDICAID |