NPIMap

Organization Active NPI

Eastside ENT Specialists, Inc

  • Specialist
  • Painesville, OH
National Provider Identifier
1215907845
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
EASTSIDE ENT SPECIALISTS, INC
Practice address
7580 Auburn Road
#103
Painesville, OH 44077
Phone
(440) 352-1474
Fax
(440) 352-2662
NPI assigned
Jan 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. E. Luke Bold, M.D.
Title
Vice President
Phone
(440) 352-1474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

7580 Auburn Road
#103
Painesville, OH 44077

Mailing address

7580 Auburn Road
#103
Painesville, OH 44077
Phone (440) 352-1474

Other identifiers 1

IdentifierTypeStateIssuer
0666364MedicaidOH

National Provider Directory

National Provider Directory

Locations

510 5th Ave
Chardon, OH 44024
Phone (440) 285-9494

7580 Auburn Rd
Ste 103
Concord Township, OH 44077
Phone (440) 352-1474

8224 Mentor Ave
Ste 126
Mentor, OH 44060
Phone (440) 205-9292

36060 Euclid Ave
Ste 201
Willoughby, OH 44094
Phone (440) 352-1474

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1215907845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7580 AUBURN ROAD",
            "address_2": "#103",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "44077",
            "telephone_number": "440-352-1474",
            "fax_number": "440-352-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7580 AUBURN ROAD",
            "address_2": "#103",
            "city": "PAINESVILLE",
            "state": "OH",
            "postal_code": "44077",
            "telephone_number": "440-352-1474",
            "fax_number": "440-352-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE ENT SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-25",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "BOLD",
        "authorized_official_first_name": "E.",
        "authorized_official_middle_name": "LUKE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "440-352-1474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0666364",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Painesville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.