Provider Demographics
NPI:1245603760
Name:CENTRAL PARK EAR NOSE AND THROAT, LLP-MANSFIELD
Entity Type:Organization
Organization Name:CENTRAL PARK EAR NOSE AND THROAT, LLP-MANSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-261-9191
Mailing Address - Street 1:221 REGENCY PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 CENTRAL PARK DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2069
Practice Address - Country:US
Practice Address - Phone:817-261-9191
Practice Address - Fax:817-784-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty