=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386535243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXHALE SINUS INDIANA CLINICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 PARK PL
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46545-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-336-0240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 PARK PL
-----------------------------------------------------
City | MISHAWAKA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46545-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-336-0240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RYAN VAUGHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-234-5880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------