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General NPI Number Information
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NPI Number | 1871761437
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Entity Type | Organization
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Legal Business Name | HEARTLAND ENT HEAD AND NECK SURGERY, LLC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 515 E PROMENADE ST
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City | MEXICO
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State | MO
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Zip | 65265-2966
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Country | US
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Telephone | 573-582-8500
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Fax | 573-582-7727
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Provider Business Mailing Address
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Address Line | 515 E PROMENADE ST
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City | MEXICO
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State | MO
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Zip | 65265-2966
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Country | US
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Telephone | 573-582-8500
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Fax | 573-582-7727
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DAVID B BOWNE
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Credential | M.D.
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Telephone | 573-582-8500
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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 | 112829
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License Number State | MO
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