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General NPI Number Information
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NPI Number | 1720280761
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Entity Type | Organization
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Legal Business Name | ENT HEARING SERVICES LC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 2730 PIERCE ST SUITE 402
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City | SIOUX CITY
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State | IA
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Zip | 51104-3796
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Country | US
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Telephone | 605-217-4320
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Fax | 605-217-4320
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Provider Business Mailing Address
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Address Line | 2730 PIERCE ST SUITE 402
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City | SIOUX CITY
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State | IA
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Zip | 51104-3796
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Country | US
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Telephone | 605-217-4320
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Fax | 605-217-4320
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLY ANNE JERDEE
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Credential |
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Telephone | 605-217-4320
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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 | 34004
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License Number State | IA
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