Provider Demographics
NPI:1033319140
Name:MISSOURI EAR NOSE AND THROAT CENTER
Entity Type:Organization
Organization Name:MISSOURI EAR NOSE AND THROAT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:573-808-0492
Mailing Address - Street 1:3401 BERRYWOOD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6515
Mailing Address - Country:US
Mailing Address - Phone:573-815-0662
Mailing Address - Fax:573-443-1162
Practice Address - Street 1:3401 BERRYWOOD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6515
Practice Address - Country:US
Practice Address - Phone:573-815-0662
Practice Address - Fax:573-443-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty