Provider Demographics
NPI:1407852213
Name:SUSIE EARLY MD PC
Entity Type:Organization
Organization Name:SUSIE EARLY MD PC
Other - Org Name:ELIZABETH K. EARLY, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-874-6984
Mailing Address - Street 1:303 NORTH KEENE STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-874-6984
Mailing Address - Fax:573-874-8737
Practice Address - Street 1:303 NORTH KEENE STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-874-6984
Practice Address - Fax:573-874-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507255107Medicaid
MO661525OtherHEALTHLINK
MODB8490OtherRAILROAD MEDICARE
MO48602OtherHEALTHCARE USA
MO190084OtherBLUE CROSS BLUE SHIELD
MO497844546EAROtherMERCY
MO=========OtherTRICARE
MO661525OtherHEALTHLINK