Organization
HEAD AND NECK SURGERY ASSOCIATES, PSC
Active
Other names
ENT & Allergy Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA DETRICK (COO)
(859) 572-4104
Entity
Organization
Contact information
Practice address
40 N GRAND AVE, SUITE 101, FORT THOMAS, KY 41075-4107
(859) 781-4900
(859) 572-3045
Mailing address
40 N GRAND AVE, SUITE 101, FORT THOMAS, KY 41075-4107
(859) 781-4900
(859) 572-3045
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
207YX0901X
Otology & Neurotology Physician
—
—
231H00000X
Audiologist
—
—
237700000X
Hearing Instrument Specialist
—
KY
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100015770
—
IN
05
—
65917965
—
KY
05
—
701342
—
OH
05
—
7100266460
—
KY
Enumeration date
11/01/2006
Last updated
10/18/2019
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