Provider Demographics
NPI:1730230764
Name:EAR, NOSE, AND THROAT ASSOCIATES OF MANATEE, PA
Entity type:Organization
Organization Name:EAR, NOSE, AND THROAT ASSOCIATES OF MANATEE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERBY
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:941-748-2455
Mailing Address - Street 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-748-2455
Mailing Address - Fax:941-750-9704
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 202
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-748-2455
Practice Address - Fax:941-750-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85106174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99617OtherGROUP NUMBER