Healthcare Provider Details

I. General information

NPI: 1376975219
Provider Name (Legal Business Name): FLAVILL INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MAIN ST SUITE 105
WILMINGTON OH
45177-2170
US

IV. Provider business mailing address

630 W MAIN ST SUITE 105
WILMINGTON OH
45177-2170
US

V. Phone/Fax

Practice location:
  • Phone: 937-283-2020
  • Fax: 937-283-2021
Mailing address:
  • Phone: 937-283-2020
  • Fax: 937-283-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.121145
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number35.121145
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number35.121145
License Number StateOH

VIII. Authorized Official

Name: DR. ERIC C. FLAVILL
Title or Position: OWNER
Credential: MD
Phone: 937-283-2020