Healthcare Provider Details

I. General information

NPI: 1811089675
Provider Name (Legal Business Name): ENT ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD SUITE 37W
CHESTERFIELD MO
63017-3662
US

IV. Provider business mailing address

226 S WOODS MILL RD SUITE 37W
CHESTERFIELD MO
63017-3662
US

V. Phone/Fax

Practice location:
  • Phone: 314-523-5303
  • Fax: 314-523-5703
Mailing address:
  • Phone: 314-523-5303
  • Fax: 314-523-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS MARIE LAWRENCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-523-5303