Healthcare Provider Details

I. General information

NPI: 1497880504
Provider Name (Legal Business Name): ENTEGRITY EAR, NOSE AND THROAT SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 E CHAUNCEY LN SUITE 100
PHOENIX AZ
85054-5155
US

IV. Provider business mailing address

6950 E CHAUNCEY LN SUITE 100
PHOENIX AZ
85054-5155
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-5090
  • Fax: 602-494-5055
Mailing address:
  • Phone: 602-494-5090
  • Fax: 602-494-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26487
License Number StateAZ

VIII. Authorized Official

Name: MRS. JACKIE LAMOINE SIDES
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 602-494-5090