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General NPI Number Information
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NPI Number | 1699022137
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Entity Type | Organization
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Legal Business Name | CHRISTIAN EAR NOSE THROAT
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 1830 HIGH ST SUITE B
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1746
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Country | US
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Telephone | 270-885-5525
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Fax | 270-885-1811
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Provider Business Mailing Address
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Address Line | 1830 HIGH ST SUITE B
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1746
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Country | US
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Telephone | 270-885-5525
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Fax | 270-885-1811
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CHARLES W BOSCH
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Credential | DO
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Telephone | 270-885-5525
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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 | 03508
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License Number State | KY
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