Healthcare Provider Details

I. General information

NPI: 1043306020
Provider Name (Legal Business Name): EAR, NOSE AND THROAT ASSOCIATES OF ASHLAND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CARTER AVE
ASHLAND KY
41101-7830
US

IV. Provider business mailing address

2550 CARTER AVE
ASHLAND KY
41101-7830
US

V. Phone/Fax

Practice location:
  • Phone: 606-325-8561
  • Fax: 606-325-3591
Mailing address:
  • Phone: 606-325-8561
  • Fax: 606-325-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number02952
License Number StateKY

VIII. Authorized Official

Name: DR. JON A BRINKMAN
Title or Position: OWNER
Credential: DO
Phone: 606-325-8561