Provider Demographics
NPI:1568615334
Name:HIGH PLAINS EAR NOSE & THROAT ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HIGH PLAINS EAR NOSE & THROAT ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-355-8293
Mailing Address - Street 1:5211 W 9TH AVE
Mailing Address - Street 2:#104
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4120
Mailing Address - Country:US
Mailing Address - Phone:806-355-8293
Mailing Address - Fax:806-355-7298
Practice Address - Street 1:5211 W 9TH AVE
Practice Address - Street 2:#104
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4120
Practice Address - Country:US
Practice Address - Phone:806-355-8293
Practice Address - Fax:806-355-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0325174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00307WMedicare PIN