Provider Demographics
NPI:1932271145
Name:MCINTEE EAR, NOSE & THROAT, SC
Entity type:Organization
Organization Name:MCINTEE EAR, NOSE & THROAT, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-224-4687
Mailing Address - Street 1:2040 W ILES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4183
Mailing Address - Country:US
Mailing Address - Phone:217-789-0668
Mailing Address - Fax:
Practice Address - Street 1:1132 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2819
Practice Address - Country:US
Practice Address - Phone:217-224-4687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100190207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP04677Medicare ID - Type Unspecified
K13570Medicare ID - Type Unspecified