Provider Demographics
NPI:1043282668
Name:ENT SPECIALISTS PC
Entity type:Organization
Organization Name:ENT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-0670
Mailing Address - Street 1:720 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-6109
Mailing Address - Country:US
Mailing Address - Phone:402-397-0670
Mailing Address - Fax:402-397-0713
Practice Address - Street 1:720 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-6109
Practice Address - Country:US
Practice Address - Phone:402-397-0670
Practice Address - Fax:402-397-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE095345Medicare UPIN