Healthcare Provider Details

I. General information

NPI: 1467502534
Provider Name (Legal Business Name): EWING-EAR, NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GREENBRIAR DR SUITE A
CAMPBELLSVILLE KY
42718-9617
US

IV. Provider business mailing address

105 GREENBRIAR DR SUITE A
CAMPBELLSVILLE KY
42718-9617
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-3595
  • Fax: 270-789-2044
Mailing address:
  • Phone: 270-465-3595
  • Fax: 270-789-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number29697
License Number StateKY

VIII. Authorized Official

Name: DR. JAMES E EWING
Title or Position: OWNER
Credential: MD
Phone: 270-465-3595