Provider Demographics
NPI:1467583898
Name:ARIZONA COAST EAR, NOSE & THROAT, LTD.
Entity Type:Organization
Organization Name:ARIZONA COAST EAR, NOSE & THROAT, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-854-5368
Mailing Address - Street 1:1760 MCCULLOCH BLVD N
Mailing Address - Street 2:STE. 100
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6559
Mailing Address - Country:US
Mailing Address - Phone:928-854-5368
Mailing Address - Fax:928-854-4462
Practice Address - Street 1:1760 MCCULLOCH BLVD N
Practice Address - Street 2:STE. 100
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6559
Practice Address - Country:US
Practice Address - Phone:928-854-5368
Practice Address - Fax:928-854-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ66231Medicare PIN