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NPI Code Detail

MEDICARE: EAR NOSE & THROAT CARE, PA

MEDICARE: EAR NOSE & THROAT CARE, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YX0007XPlastic Surgery within the Head & Neck (Otolaryngology) PhysicianH2880TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013026228
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAR NOSE & THROAT CARE, PA
Provider Business Mailing Address
First Line : 2448 W ILLINOIS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75233-1106
Country : US
Telephone Number : 214-330-7028
Fax Number : 214-330-8497
Provider Business Practice Location Address
First Line : 2448 W ILLINOIS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75233-1106
Country : US
Telephone Number : 214-330-7028
Fax Number : 214-330-8497
Authorized Official
Title or Position : PHYSICIAN/SECRETARY OF PA
Name : LYNDA VISHER-WEST
Credential : DO
Telephone Number : 214-330-7028
Provider Enumeration Date : 08/30/2006
Last Update Date : 03/04/2020

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Directions to “EAR NOSE & THROAT CARE, PA ” Practice Location

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