MEDICARE: MIDWEST EAR NOSE AND THROAT LLC

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		KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110356	OTHER	KS	KS MEDICARE
4	CE8450	OTHER	KS	MEDICARE RAILROAD
5	D44000	OTHER	KS	KC MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	14136024	OTHER		BCBS - KC
3	702788	OTHER		BCBS - KS

General Provider Information

NPI Number	:	1184622730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EAR NOSE AND THROAT LLC

Provider Business Mailing Address
First Line	:	PO BOX 874480
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64187-0001
Country	:	US
Telephone Number	:	913-764-2737
Fax Number	:	913-764-7502

Provider Business Practice Location Address
First Line	:	20375 W 151ST ST
Second Line	:	STE #106
City	:	OLATHE
State	:	KS
Zip	:	66061
Country	:	US
Telephone Number	:	913-764-2737
Fax Number	:	913-764-7502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN A METZ
Credential	:	MD
Telephone Number	:	913-764-2737

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/17/2024

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Directions to “MIDWEST EAR NOSE AND THROAT LLC ” Practice Location

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