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ENT REALTY CORP

Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical

Provider NPI: 1588640353

Organization Information:
Organization Name:  ENT REALTY CORP
Organization is not Subpart
Authorized Official:  BILL  EHINGER  CEO  260-207-1675

Practice Location:
7900 W JEFFERSON BLVD SUITE 102 FORT WAYNE, IN 46804-4128 US
Tel: 260-432-4368  Fax: 260-436-6283

Business Mailing Address:
10021 DUPONT CIRCLE CT  FORT WAYNE, IN 46825-1604 US
Tel: 260-426-8117  Fax: 260-420-0817

NPI Information:
NPI: 1588640353
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QA1903XAmbulatory Health Care Facilities
Clinic/Center
Ambulatory Surgical

Other Provider Identifiers:

IssuerNumberStateType
200138850IN05



American Medical Association 2012 taxonomy code information

Code: 261QA1903X

Type:

Classification:



Definition:



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