MEDICARE: LAS COLINAS EAR NOSE THROAT AND ALLERGY PA

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	K8361	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396815395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS COLINAS EAR NOSE THROAT AND ALLERGY PA

Provider Business Mailing Address
First Line	:	7449 LAS COLINAS BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7561
Country	:	US
Telephone Number	:	972-432-8282
Fax Number	:	972-432-0552

Provider Business Practice Location Address
First Line	:	7449 LAS COLINAS BLVD STE 100
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-8047
Country	:	US
Telephone Number	:	972-432-8282
Fax Number	:	972-432-0552

Authorized Official
Title or Position	:	MANAGER
Name	:	ANGELA MCKAY
Credential	:
Telephone Number	:	972-432-8282

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	05/28/2024

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