Healthcare Provider Details

I. General information

NPI: 1265511687
Provider Name (Legal Business Name): EAR,NOSE,AND THROAT PLASTIC SURGERY OF WARRENSBURG, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N BURKARTH RD
WARRENSBURG MO
64093-9303
US

IV. Provider business mailing address

706 N BURKARTH RD
WARRENSBURG MO
64093-9303
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-5444
  • Fax: 660-747-5481
Mailing address:
  • Phone: 660-747-5444
  • Fax: 660-747-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number101381
License Number StateMO

VIII. Authorized Official

Name: MARK LEWIS HECHLER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 660-747-5444