Provider Demographics
NPI:1124782842
Name:OTOLARYNGOLOGY ASSOCIATES OF NORTHWEST INDIANA LLC
Entity type:Organization
Organization Name:OTOLARYNGOLOGY ASSOCIATES OF NORTHWEST INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-9368
Mailing Address - Street 1:2211 MAIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3514
Mailing Address - Country:US
Mailing Address - Phone:219-836-9368
Mailing Address - Fax:219-836-9357
Practice Address - Street 1:2211 MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3514
Practice Address - Country:US
Practice Address - Phone:219-836-9368
Practice Address - Fax:219-836-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty