MEDICARE: OTOLARYNGOLOGY ASSOCIATES, LLC

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
2	207Y00000X	Otolaryngology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC1971	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1447398839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTOLARYNGOLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	9002 NORTH MERIDIAN STREET
Second Line	:	SUITE 222
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5350
Country	:	US
Telephone Number	:	317-573-4370
Fax Number	:	317-819-0044

Provider Business Practice Location Address
First Line	:	9002 NORTH MERIDIAN STREET
Second Line	:	SUITE 222
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5350
Country	:	US
Telephone Number	:	317-573-4370
Fax Number	:	317-819-0044

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS H FAIRCHILD
Credential	:	M.D.
Telephone Number	:	317-844-7059

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/23/2014

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Directions to “OTOLARYNGOLOGY ASSOCIATES, LLC ” Practice Location

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