Provider Demographics
NPI:1578788451
Name:SOUTHWEST EAR, NOSE & THROAT INSTITUTE, PA
Entity Type:Organization
Organization Name:SOUTHWEST EAR, NOSE & THROAT INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMANG
Authorized Official - Middle Name:
Authorized Official - Last Name:KHETARPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-990-2700
Mailing Address - Street 1:1011 MEDICAL PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3248
Mailing Address - Country:US
Mailing Address - Phone:832-990-2700
Mailing Address - Fax:832-789-9400
Practice Address - Street 1:1011 MEDICAL PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3248
Practice Address - Country:US
Practice Address - Phone:832-990-2700
Practice Address - Fax:832-789-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0330174400000X
207Y00000X, 207YS0012X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCH3849OtherMEDICARE RAILROAD
TX0091EMOtherBC/BS
TX081309901Medicaid
TX00879NMedicare PIN