1083886972 NPI number — MISSOURI EAR NOSE AND THROAT CENTER

Table of content: (NPI 1083886972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083886972 NPI number — MISSOURI EAR NOSE AND THROAT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOURI EAR NOSE AND THROAT CENTER
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:
6
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:
1083886972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 WEST NIFONG BLVD
Provider Second Line Business Mailing Address:
BUILDING 3 SUITE 100
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-214-2000
Provider Business Mailing Address Fax Number:
573-214-2042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WEST NIFONG BLVD
Provider Second Line Business Practice Location Address:
BUILDING 3 SUITE 100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-214-2000
Provider Business Practice Location Address Fax Number:
573-214-2042
Provider Enumeration Date:
03/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEIDT
Authorized Official First Name:
TROY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
573-214-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  112260 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 208666503 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209107309 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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