Healthcare Provider Details

I. General information

NPI: 1295806081
Provider Name (Legal Business Name): ENT ASSOCIATES OF SOUTHERN INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 556
LINTON IN
47441-9587
US

IV. Provider business mailing address

2920 MCINTYRE DR STE 350
BLOOMINGTON IN
47403-4221
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-8664
  • Fax:
Mailing address:
  • Phone: 812-332-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number50000616A
License Number StateIN

VIII. Authorized Official

Name: DENISE LYNN WEST
Title or Position: OFFICE MANAGER
Credential:
Phone: 812-332-2226