Provider Demographics
NPI:1275510737
Name:PANHANDLE EAR NOSE & THROAT ASSOCIATES LLP
Entity Type:Organization
Organization Name:PANHANDLE EAR NOSE & THROAT ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-355-5625
Mailing Address - Street 1:3501 S SONCY RD
Mailing Address - Street 2:STE 140
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6407
Mailing Address - Country:US
Mailing Address - Phone:806-355-5625
Mailing Address - Fax:806-352-2245
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:STE 140
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-355-5625
Practice Address - Fax:806-352-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165089701Medicaid
TX0094JKOtherBCBS
TXCK5578OtherRR MEDICARE
TX165089701Medicaid