MEDICARE: EAR NOSE AND THROAT ASSOCIATES S C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1245378470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR NOSE AND THROAT ASSOCIATES S C

Provider Business Mailing Address
First Line	:	7350 W COLLEGE DR STE 208
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1189
Country	:	US
Telephone Number	:	708-361-9199
Fax Number	:	708-361-9299

Provider Business Practice Location Address
First Line	:	7350 W COLLEGE DR STE 208
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1189
Country	:	US
Telephone Number	:	708-361-9199
Fax Number	:	708-361-9299

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. GAIL C BARRETT
Credential	:
Telephone Number	:	708-361-9199

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/19/2012

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