=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720183163
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISEASES OF THE EARS, NOSE AND THROAT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 TAYLOR STATION ROAD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-6293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-759-8811
-----------------------------------------------------
Fax | 614-759-6506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 TAYLOR STATION ROAD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-6293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-759-8811
-----------------------------------------------------
Fax | 614-759-6506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER OWNER
-----------------------------------------------------
Name | DR. TIMOTHY J NASH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 614-759-8811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------