Provider Demographics
NPI:1174608723
Name:EAR, NOSE & THROAT ASSOCIATES
Entity type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-3221
Mailing Address - Street 1:700 SHADOW LANE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-382-3221
Mailing Address - Fax:702-382-1822
Practice Address - Street 1:700 SHADOW LN
Practice Address - Street 2:SUITE 235
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4126
Practice Address - Country:US
Practice Address - Phone:702-382-3221
Practice Address - Fax:702-382-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV038511480174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508181Medicaid
NVCQ3081OtherRR MEDICARE
NV100508181Medicaid