Provider Demographics
NPI:1396815395
Name:LAS COLINAS EAR NOSE THROAT AND ALLERGY
Entity Type:Organization
Organization Name:LAS COLINAS EAR NOSE THROAT AND ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-432-8282
Mailing Address - Street 1:7449 LAS COLINAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7561
Mailing Address - Country:US
Mailing Address - Phone:972-432-8282
Mailing Address - Fax:972-432-0552
Practice Address - Street 1:7449 LAS COLINAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-8047
Practice Address - Country:US
Practice Address - Phone:972-432-8282
Practice Address - Fax:972-432-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8361207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171043601Medicaid
TX171043601Medicaid
TX8C9596Medicare PIN
TXF71291Medicare UPIN