LAKE GROVE ENT PC – NPI #1043211824
Otolaryngology

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

LAKE GROVE ENT PC is an otolaryngologist located in LAKE OSWEGO, OR. NPPES has assigned the NPI number 1043211824 to LAKE GROVE ENT PC on August 03, 2005. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207Y00000X from the Health Care Provider Taxonomy code set, which is classified as Otolaryngology.

The NPI profile was previously updated about 4 years ago on Apr 04, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for LAKE GROVE ENT PC below.

NPI Profile for
LAKE GROVE ENT PC

NPI Number
1043211824
Enumeration Date

(about 21 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
LAKE GROVE ENT PC
Primary location
17704 JEAN WAY
STE 101
LAKE OSWEGO, OR 97035-5497
Phone: (503) 699-0370 Fax: (971) 236-9099
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
CHERYL KRUSE
CLINIC MANAGER
Phone: (503) 699-0370
Updated
Certification Date
Apr 04, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for LAKE GROVE ENT PC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDOR005809
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207Y00000X
- Otolaryngology (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.