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General NPI Number Information
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NPI Number | 1114037322
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Entity Type | Organization
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Legal Business Name | EMPORIA HEAD NECK P.A.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1130 CHESTNUT ST
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City | EMPORIA
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State | KS
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Zip | 66801-2549
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Country | US
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Telephone | 620-343-3533
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Fax | 620-343-7239
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Provider Business Mailing Address
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Address Line | 1130 CHESTNUT ST
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City | EMPORIA
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State | KS
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Zip | 66801-2549
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Country | US
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Telephone | 620-343-3533
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Fax | 620-343-7239
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NORMAN ALBERT FORDYCE
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Credential | M.D.
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Telephone | 620-343-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-13951
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License Number State | KS
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