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General NPI Number Information
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NPI Number | 1790733012
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Entity Type | Organization
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Legal Business Name | OLD WESTPORT ENT & ALLERGY, INC
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1004 CARONDELET DR SUITE 450
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City | KANSAS CITY
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State | MO
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Zip | 64114-4802
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Country | US
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Telephone | 816-942-7200
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Fax | 816-942-2767
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Provider Business Mailing Address
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Address Line | 216 NW EXECUTIVE WAY
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City | LEES SUMMIT
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State | MO
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Zip | 64063-1841
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Country | US
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Telephone | 816-875-2599
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Fax | 816-875-2598
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. DEE ANN BOWLES
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Credential | BS,MS
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Telephone | 816-875-2599
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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 |
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