Provider Demographics
NPI:1417039512
Name:ALLERGY EARS NOSE & THROAT OF GREENVILLE PA
Entity type:Organization
Organization Name:ALLERGY EARS NOSE & THROAT OF GREENVILLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:RIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-454-6481
Mailing Address - Street 1:3000 HORIZON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5817
Mailing Address - Country:US
Mailing Address - Phone:903-454-6481
Mailing Address - Fax:903-454-6486
Practice Address - Street 1:3000 HORIZON RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5817
Practice Address - Country:US
Practice Address - Phone:903-454-6481
Practice Address - Fax:903-454-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080065801Medicaid
TX00173KMedicare PIN
TX080065801Medicaid