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General NPI Number Information
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NPI Number | 1356524433
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Entity Type | Organization
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Legal Business Name | MIDWEST EAR NOSE & THROAT SPECIALISTS PC
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 614 S MAIN
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City | SMITH CENTER
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State | KS
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Zip | 66967
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Country | US
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Telephone | 402-463-2431
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Fax |
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Provider Business Mailing Address
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Address Line | SUITE 203 2115 N KANSAS AVE
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City | HASTINGS
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State | NE
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Zip | 68901
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Country | US
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Telephone | 402-463-2431
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DAVID P LONG
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Credential |
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Telephone | 402-463-2431
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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 | 04-28746
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License Number State | KS
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