Provider Demographics
NPI:1023001450
Name:MIDWEST EAR NOSE & THROAT CTR PC
Entity Type:Organization
Organization Name:MIDWEST EAR NOSE & THROAT CTR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-875-2599
Mailing Address - Street 1:216 NW EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1841
Mailing Address - Country:US
Mailing Address - Phone:816-875-2599
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:4880 NW GOODVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-478-4200
Practice Address - Fax:816-478-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF40456Medicare UPIN
MOE04839Medicare UPIN
MOC51217Medicare UPIN
MOE07433Medicare UPIN