Provider Demographics
NPI:1508146382
Name:EAR NOSE & THROAT CENTERS OF TEXAS
Entity Type:Organization
Organization Name:EAR NOSE & THROAT CENTERS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-984-1050
Mailing Address - Street 1:4510 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1650
Mailing Address - Country:US
Mailing Address - Phone:972-984-1050
Mailing Address - Fax:972-984-1376
Practice Address - Street 1:4510 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:972-984-1050
Practice Address - Fax:972-984-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0462207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty