Provider Demographics
NPI:1053504878
Name:UNITED OTOLARYNGOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:UNITED OTOLARYNGOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-9840
Mailing Address - Street 1:300 BEARDSLEY LN
Mailing Address - Street 2:SUITE D101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4945
Mailing Address - Country:US
Mailing Address - Phone:512-338-9840
Mailing Address - Fax:512-338-0863
Practice Address - Street 1:300 BEARDSLEY LN
Practice Address - Street 2:SUITE D101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4945
Practice Address - Country:US
Practice Address - Phone:512-338-9840
Practice Address - Fax:512-338-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193801101Medicaid
TX193801101Medicaid