Provider Demographics
NPI:1366572158
Name:EAR NOSE AND THROAT ASSOCIATES OF GRANTS PASS PC
Entity type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES OF GRANTS PASS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-476-7775
Mailing Address - Street 1:1600 NW 6TH ST
Mailing Address - Street 2:SOUTH SUITE
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1094
Mailing Address - Country:US
Mailing Address - Phone:541-476-7775
Mailing Address - Fax:541-476-3572
Practice Address - Street 1:1600 NW 6TH ST
Practice Address - Street 2:SOUTH SUITE
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1094
Practice Address - Country:US
Practice Address - Phone:541-476-7775
Practice Address - Fax:541-476-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19356207YX0905X
ORDO20532207YX0905X
ORMD10466207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232900Medicaid
OR073655Medicaid
OR150358Medicaid
OROOWCGMKDMedicare ID - Type Unspecified
ORG05255Medicare UPIN
OROOWCGMKAMedicare ID - Type Unspecified
ORG50481Medicare UPIN
OR232900Medicaid
OR150358Medicaid