Healthcare Provider Details

I. General information

NPI: 1326001363
Provider Name (Legal Business Name): MONTGOMERY EAR NOSE & THROAT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 MONTGOMERY RD #2B
CINCINNATI OH
45242-7789
US

IV. Provider business mailing address

9200 MONTGOMERY RD #2B
CINCINNATI OH
45242-7789
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-8700
  • Fax: 513-891-8703
Mailing address:
  • Phone: 513-891-8700
  • Fax: 513-891-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number34004051
License Number StateOH

VIII. Authorized Official

Name: JAMEE L KRUSE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 513-891-8700