Provider Demographics
NPI:1629094214
Name:EAR NOSE & THROAT SURGICAL ASSOCIATES SC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT SURGICAL ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-734-7181
Mailing Address - Street 1:1520 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3762
Mailing Address - Country:US
Mailing Address - Phone:920-734-7181
Mailing Address - Fax:920-734-0621
Practice Address - Street 1:1520 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3762
Practice Address - Country:US
Practice Address - Phone:920-734-7181
Practice Address - Fax:920-734-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty