Basic Information
| Provider Information | |||||||||
| NPI: | 1942489042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BILTMORE EAR NOSE AND THROAT, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 N 32ND ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850183953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029561250 | ||||||||
| FaxNumber: | 6029567466 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 N 32ND ST | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850183953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029561250 | ||||||||
| FaxNumber: | 6029567466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2007 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | TAFFET | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6029561250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 16326 | AZ | N | Managed Care Organizations | Preferred Provider Organization | 207Y00000X | 16326 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 849455 | 05 | AZ | MEDICAID |