Provider Demographics
NPI:1265511687
Name:EAR,NOSE,AND THROAT PLASTIC SURGERY OF WARRENSBURG, P.C.
Entity Type:Organization
Organization Name:EAR,NOSE,AND THROAT PLASTIC SURGERY OF WARRENSBURG, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:HECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-747-5444
Mailing Address - Street 1:706 N BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9303
Mailing Address - Country:US
Mailing Address - Phone:660-747-5444
Mailing Address - Fax:660-747-5481
Practice Address - Street 1:706 N BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9303
Practice Address - Country:US
Practice Address - Phone:660-747-5444
Practice Address - Fax:660-747-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-05
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101381207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506292705Medicaid
22873017OtherBLUE CROSS/BLUE SHIELD OF KANSAS CITY
N690000Medicare PIN