Provider Demographics
NPI:1144412990
Name:IRVING COPPELL EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:IRVING COPPELL EAR, NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLAINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-402-8404
Mailing Address - Street 1:400 W IH 635 FWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-402-8404
Mailing Address - Fax:972-402-9301
Practice Address - Street 1:400 W IH 635 FWY
Practice Address - Street 2:SUITE 360
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-402-8404
Practice Address - Fax:972-402-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3844207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0055AKMedicare PIN