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General NPI Number Information
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NPI Number | 1134241706
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Entity Type | Organization
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Legal Business Name | OTOLARYNGOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 2312 S DIXON RD STE 200
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City | KOKOMO
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State | IN
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Zip | 46902-6423
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Country | US
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Telephone | 317-844-7059
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Fax | 317-573-4352
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Provider Business Mailing Address
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Address Line | 9002 N MERIDIAN ST STE 222
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5350
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Country | US
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Telephone | 317-573-4370
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Fax | 317-819-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS H FAIRCHILD
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Credential | M.D.
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Telephone | 317-844-7059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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