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General NPI Number Information
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NPI Number | 1033319140
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Entity Type | Organization
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Legal Business Name | MISSOURI EAR NOSE AND THROAT CENTER
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 3401 BERRYWOOD DR SUITE 201
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City | COLUMBIA
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State | MO
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Zip | 65201-6515
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Country | US
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Telephone | 573-815-0662
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Fax | 573-443-1162
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Provider Business Mailing Address
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Address Line | 3401 BERRYWOOD DR SUITE 201
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City | COLUMBIA
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State | MO
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Zip | 65201-6515
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Country | US
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Telephone | 573-815-0662
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Fax | 573-443-1162
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WILLIAM CHARLES KINNEY SR.
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Credential | MD
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Telephone | 573-808-0492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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