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General NPI Number Information
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NPI Number | 1083689889
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Entity Type | Organization
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Legal Business Name | WANLESS EAR, NOSE & THROAT LLC
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1513 UNION AVE STE 1200
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City | MOBERLY
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State | MO
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Zip | 65270-9405
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Country | US
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Telephone | 660-263-4600
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Fax | 660-263-4640
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Provider Business Mailing Address
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Address Line | 1513 UNION AVE STE 1200
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City | MOBERLY
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State | MO
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Zip | 65270-9405
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Country | US
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Telephone | 660-263-4600
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Fax | 660-263-4640
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | KIRK M. WANLESS
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Credential | MD
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Telephone | 660-263-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | MO
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