1093839342 NPI number — EAR, NOSE AND THROAT ASSOCIATES OF FRISCO, P.A.

Table of content: (NPI 1093839342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093839342 NPI number — EAR, NOSE AND THROAT ASSOCIATES OF FRISCO, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR, NOSE AND THROAT ASSOCIATES OF FRISCO, P.A.
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:
1093839342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 COIT RD
Provider Second Line Business Mailing Address:
SUITE 411
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-731-7654
Provider Business Mailing Address Fax Number:
972-731-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 COIT RD
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-0500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-731-7654
Provider Business Practice Location Address Fax Number:
972-731-6226
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEHENDALE
Authorized Official First Name:
NEELESH
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-731-7654

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0015LM . This is a "GROUP BCBS ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DC5894 . This is a "GROUP RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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