Provider Demographics
NPI:1902929615
Name:EAR,NOSE AND THROAT SPECIALISTS, L.L.C.
Entity Type:Organization
Organization Name:EAR,NOSE AND THROAT SPECIALISTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-9882
Mailing Address - Street 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7366
Mailing Address - Country:US
Mailing Address - Phone:318-322-9882
Mailing Address - Fax:318-322-2006
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7366
Practice Address - Country:US
Practice Address - Phone:318-322-9882
Practice Address - Fax:318-322-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1441546Medicaid
LAF8532OtherBLUE CROSS OF LOUISIANA
LA5C874Medicare ID - Type Unspecified