Provider Demographics
NPI:1053382689
Name:OHIO VALLEY ENT, INC
Entity type:Organization
Organization Name:OHIO VALLEY ENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-325-8796
Mailing Address - Street 1:435 S BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2717
Mailing Address - Country:US
Mailing Address - Phone:937-325-8796
Mailing Address - Fax:937-325-3640
Practice Address - Street 1:435 S BURNETT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-2717
Practice Address - Country:US
Practice Address - Phone:937-325-8796
Practice Address - Fax:937-325-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0429852Medicaid
OHCB1116OtherRAILROAD MEDICARE
OH0429852Medicaid