1063636470 NPI number — EAR NOSE AND THROAT CONSULTANTS AND HEARING SERVICES PLC

Table of content: (NPI 1063636470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063636470 NPI number — EAR NOSE AND THROAT CONSULTANTS AND HEARING SERVICES PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR NOSE AND THROAT CONSULTANTS AND HEARING SERVICES PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063636470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2916 HAMILTON BLVD
Provider Second Line Business Mailing Address:
LOWER C SUITE 103
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-252-1201
Provider Business Mailing Address Fax Number:
712-252-0512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2916 HAMILTON BLVD
Provider Second Line Business Practice Location Address:
LOWER C SUITE 103
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-252-1201
Provider Business Practice Location Address Fax Number:
712-252-0512
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KENNY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
712-252-5203

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  34004 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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