MEDICARE: ENT ASSOCIATES OF NORTHEAST LOUISIANA, 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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1740530427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT ASSOCIATES OF NORTHEAST LOUISIANA, LLC

Provider Business Mailing Address
First Line	:	2802 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5139
Country	:	US
Telephone Number	:	318-855-6282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 KILPATRICK BLVD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-5139
Country	:	US
Telephone Number	:	318-855-6282
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. WILSON T BARHAM
Credential	:	MD
Telephone Number	:	318-855-6282

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	09/11/2012

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