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General NPI Number Information
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NPI Number | 1326001363
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Entity Type | Organization
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Legal Business Name | MONTGOMERY EAR NOSE & THROAT CLINIC INC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 9200 MONTGOMERY RD #2B
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City | CINCINNATI
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State | OH
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Zip | 45242-7789
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Country | US
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Telephone | 513-891-8700
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Fax | 513-891-8703
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Provider Business Mailing Address
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Address Line | 9200 MONTGOMERY RD #2B
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City | CINCINNATI
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State | OH
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Zip | 45242-7789
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Country | US
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Telephone | 513-891-8700
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Fax | 513-891-8703
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JAMEE L KRUSE
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Credential |
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Telephone | 513-891-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 34004051
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License Number State | OH
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