=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376542316
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO ENT SURGEONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1810 MACKENZIE DR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-273-2250
-----------------------------------------------------
Fax | 614-273-2255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 974 BETHEL RD SUITE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-2467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-538-2424
-----------------------------------------------------
Fax | 614-538-2418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. RICHARD T IRENE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 614-538-2424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | 35032586
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------