Provider Demographics
NPI:1265646368
Name:EAR NOSE & THROAT CONSULTANTS OF NORTH MISSISSIPPI PLLC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT CONSULTANTS OF NORTH MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-1337
Mailing Address - Street 1:497 AZALEA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7907
Mailing Address - Country:US
Mailing Address - Phone:662-234-1337
Mailing Address - Fax:662-281-1490
Practice Address - Street 1:497 AZALEA DR STE 101
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7907
Practice Address - Country:US
Practice Address - Phone:662-234-1337
Practice Address - Fax:662-281-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02653Medicare ID - Type UnspecifiedCLINIC CODE