Provider Demographics
NPI:1003871419
Name:MIDWEST EAR, NOSE & THROAT ASSOCIATES P C
Entity Type:Organization
Organization Name:MIDWEST EAR, NOSE & THROAT ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNOOZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-275-1211
Mailing Address - Street 1:2315 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5046
Mailing Address - Country:US
Mailing Address - Phone:605-336-3503
Mailing Address - Fax:605-336-6010
Practice Address - Street 1:2315 W 57TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-336-3503
Practice Address - Fax:605-336-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN504101500Medicaid
SD9214052OtherDAKOTACARE
MN271R7MIOtherBLUE SHIELD
SD4996180OtherBLUE SHIELD
MNC03348Medicare PIN
IAI10864Medicare PIN
MN271R7MIOtherBLUE SHIELD