Provider Demographics
NPI:1407047178
Name:EDMENT, LLC
Entity Type:Organization
Organization Name:EDMENT, LLC
Other - Org Name:LAKE OZARK EAR, NOSE & THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MERTENSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-348-2775
Mailing Address - Street 1:5780 HIGHWAY 54
Mailing Address - Street 2:SUITE 113
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3043
Mailing Address - Country:US
Mailing Address - Phone:573-348-2775
Mailing Address - Fax:573-348-1284
Practice Address - Street 1:5780 HIGHWAY 54
Practice Address - Street 2:SUITE 113
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3043
Practice Address - Country:US
Practice Address - Phone:573-348-2775
Practice Address - Fax:573-348-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013945207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty