Provider Demographics
NPI:1568659019
Name:CENTRAL COAST HEAD & NECK SURGEONS A M C INC
Entity Type:Organization
Organization Name:CENTRAL COAST HEAD & NECK SURGEONS A M C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-422-8798
Mailing Address - Street 1:1095 LOS PALOS DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-775-0205
Mailing Address - Fax:
Practice Address - Street 1:966 CASS ST
Practice Address - Street 2:STE 250
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4539
Practice Address - Country:US
Practice Address - Phone:831-649-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066351Medicaid
CN7995OtherRALILROAD MEDICARE
ZZZ14379ZMedicare PIN