Organization
BEDFORD EAR NOSE & THROAT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRASOON KUMAR SAMADDAR M.D. (OWNER)
(812) 279-4304
Entity
Organization
Contact information
Practice address
1706 24TH ST, BEDFORD, IN 47421-4708
(812) 279-4304
(812) 275-8441
Mailing address
PO BOX 1178, BEDFORD, IN 47421-1178
(812) 279-4304
(812) 275-8441
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
01026176A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184706228
—
IN
Enumeration date
07/12/2007
Last updated
03/14/2013
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