Provider Demographics
NPI:1790733012
Name:OLD WESTPORT ENT & ALLERGY, INC
Entity Type:Organization
Organization Name:OLD WESTPORT ENT & ALLERGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:BS,MS
Authorized Official - Phone:816-875-2599
Mailing Address - Street 1:216 NW EXECUTIVE WAY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1841
Mailing Address - Country:US
Mailing Address - Phone:816-875-2599
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 450
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-7200
Practice Address - Fax:816-942-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO706201OtherUNITED HEALTH CARE
KS71866OtherBCBS OF KS
MO01379020OtherBCBS OF KC
MO01379020OtherBCBS OF KC
MO706201OtherUNITED HEALTH CARE