Provider Demographics
NPI:1407490105
Name:EAR NOSE THROAT MEDICAL SERVICE
Entity Type:Organization
Organization Name:EAR NOSE THROAT MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-541-6838
Mailing Address - Street 1:1324 CLARKSON CLAYTON CTR STE 301
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2145
Mailing Address - Country:US
Mailing Address - Phone:314-541-6838
Mailing Address - Fax:
Practice Address - Street 1:226 S WOODS MILL RD STE 44W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3442
Practice Address - Country:US
Practice Address - Phone:314-447-4995
Practice Address - Fax:314-682-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty