MEDICARE: EAR NOSE AND THROAT CONSULTANTS AND HEARING SERVICES PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	34004	IA

General Provider Information

NPI Number	:	1063636470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR NOSE AND THROAT CONSULTANTS AND HEARING SERVICES PLC

Provider Business Mailing Address
First Line	:	2916 HAMILTON BLVD
Second Line	:	LOWER C SUITE 103
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2429
Country	:	US
Telephone Number	:	712-252-1201
Fax Number	:	712-252-0512

Provider Business Practice Location Address
First Line	:	2916 HAMILTON BLVD
Second Line	:	LOWER C SUITE 103
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2429
Country	:	US
Telephone Number	:	712-252-1201
Fax Number	:	712-252-0512

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS J KENNY IV
Credential	:	M.D.
Telephone Number	:	712-252-5203

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/09/2007

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