MEDICARE: MONTGOMERY EAR NOSE & THROAT CLINIC INC

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	34004051	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326001363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY EAR NOSE & THROAT CLINIC INC

Provider Business Mailing Address
First Line	:	9200 MONTGOMERY RD
Second Line	:	#2B
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7789
Country	:	US
Telephone Number	:	513-891-8700
Fax Number	:	513-891-8703

Provider Business Practice Location Address
First Line	:	9200 MONTGOMERY RD
Second Line	:	#2B
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7789
Country	:	US
Telephone Number	:	513-891-8700
Fax Number	:	513-891-8703

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JAMEE L KRUSE
Credential	:
Telephone Number	:	513-891-8700

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	11/27/2012

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