Provider Demographics
NPI:1083886972
Name:MISSOURI EAR NOSE AND THROAT CENTER
Entity Type:Organization
Organization Name:MISSOURI EAR NOSE AND THROAT CENTER
Other - Org Name:MO ENT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHEIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-214-2000
Mailing Address - Street 1:1000 WEST NIFONG BLVD
Mailing Address - Street 2:BUILDING 3 SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2966
Mailing Address - Country:US
Mailing Address - Phone:573-214-2000
Mailing Address - Fax:573-214-2042
Practice Address - Street 1:1000 WEST NIFONG BLVD
Practice Address - Street 2:BUILDING 3 SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6520
Practice Address - Country:US
Practice Address - Phone:573-214-2000
Practice Address - Fax:573-214-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112260207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208666503Medicaid
MO209107309Medicaid