Provider Demographics
NPI:1316990336
Name:ENT SPECIALISTS OF ABILENE, LLP
Entity type:Organization
Organization Name:ENT SPECIALISTS OF ABILENE, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MBA, EFPM
Authorized Official - Phone:325-437-3608
Mailing Address - Street 1:1233 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2932
Mailing Address - Country:US
Mailing Address - Phone:325-437-3687
Mailing Address - Fax:325-437-1827
Practice Address - Street 1:1233 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2932
Practice Address - Country:US
Practice Address - Phone:325-437-3687
Practice Address - Fax:325-437-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112878702OtherCIDC
TX123067OtherSUPERIOR
TX112878703Medicaid
TX040011721OtherRRMC
TX112878702OtherCIDC
TX112878703Medicaid