Organization
NORTHSIDE ENT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARVINA L GALLON (DIRECTOR OF OPERATIONS)
(317) 818-5447
Entity
Organization
Contact information
Practice address
12065 OLD MERIDIAN ST, SUITE 205, CARMEL, IN 46032-8773
(317) 844-5656
(317) 575-3795
Mailing address
12065 OLD MERIDIAN STREET, SUITE 205, CARMEL, IN 46032-8772
(317) 844-5656
(317) 575-3797
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002085A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062900A
—
IN
Enumeration date
06/11/2006
Last updated
06/17/2020
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