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Organization

OTOLARYNGOLOGY ASSOCIATES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS H FAIRCHILD M.D. (PRESIDENT)
(317) 844-7059
Entity
Organization

Contact information

Practice address
9002 NORTH MERIDIAN STREET, SUITE 222, INDIANAPOLIS, IN 46260-5350
(317) 573-4370
(317) 819-0044
Mailing address
9002 NORTH MERIDIAN STREET, SUITE 222, INDIANAPOLIS, IN 46260-5350
(317) 573-4370
(317) 819-0044

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100057100
IN
05
200838770
IN
01
CC1971
MEDICARE RAILROAD
IN
Enumeration date
02/01/2007
Last updated
07/23/2014
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