Provider Demographics
NPI:1730440108
Name:OTOLARYNGOLOGY SPECIALTY CARE, LLC
Entity type:Organization
Organization Name:OTOLARYNGOLOGY SPECIALTY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-669-1490
Mailing Address - Street 1:2345 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4473
Mailing Address - Country:US
Mailing Address - Phone:812-669-1490
Mailing Address - Fax:812-669-1491
Practice Address - Street 1:2345 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4473
Practice Address - Country:US
Practice Address - Phone:812-669-1490
Practice Address - Fax:812-669-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201078850AMedicaid
INM100073315Medicare PIN