MEDICARE: PRESCOTT EAR NOSE & THROAT PLLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1811198393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT EAR NOSE & THROAT PLLC

Provider Business Mailing Address
First Line	:	1125 W IRON SPRINGS RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1623
Country	:	US
Telephone Number	:	928-778-9190
Fax Number	:	928-776-4031

Provider Business Practice Location Address
First Line	:	1125 W IRON SPRINGS RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1623
Country	:	US
Telephone Number	:	928-778-9190
Fax Number	:	928-776-4031

Authorized Official
Title or Position	:	CORPORATE OFFICER
Name	:	DR. MARK D STRASSER
Credential	:	MD
Telephone Number	:	928-778-9190

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	06/01/2016

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