Provider Demographics
NPI:1003124538
Name:METRO EAR NOSE AND THROAT
Entity Type:Organization
Organization Name:METRO EAR NOSE AND THROAT
Other - Org Name:EAR CONSULTANTS OF THE SW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:A/R MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-781-1462
Mailing Address - Street 1:6509 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8209
Mailing Address - Country:US
Mailing Address - Phone:972-781-1462
Mailing Address - Fax:972-378-4125
Practice Address - Street 1:6509 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8209
Practice Address - Country:US
Practice Address - Phone:972-781-1462
Practice Address - Fax:972-378-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039138501Medicaid
TX00607XMedicare PIN