Provider Demographics
NPI:1720380629
Name:CENTRAL COLORADO EAR NOSE & THROAT PLLC
Entity Type:Organization
Organization Name:CENTRAL COLORADO EAR NOSE & THROAT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-539-9300
Mailing Address - Street 1:920 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9669
Mailing Address - Country:US
Mailing Address - Phone:719-539-9300
Mailing Address - Fax:719-539-9333
Practice Address - Street 1:920 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9669
Practice Address - Country:US
Practice Address - Phone:719-539-9300
Practice Address - Fax:719-539-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-28
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-48772207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty