Healthcare Provider Details

I. General information

NPI: 1265651947
Provider Name (Legal Business Name): PREMIER EAR, NOSE AND THROAT SURGEONS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE. 3025
PHOENIX AZ
85020-2412
US

IV. Provider business mailing address

9250 N 3RD ST STE. 3025
PHOENIX AZ
85020-2412
US

V. Phone/Fax

Practice location:
  • Phone: 602-678-5001
  • Fax: 602-678-4787
Mailing address:
  • Phone: 602-678-5001
  • Fax: 602-678-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN EDWARD KELLY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-678-5001