Provider Demographics
NPI:1811028186
Name:SPRINGFIELD EAR NOSE THROAT & FACIAL PLASTIC SURGERY
Entity Type:Organization
Organization Name:SPRINGFIELD EAR NOSE THROAT & FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-887-3855
Mailing Address - Street 1:3555 S CULPEPPER CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4222
Mailing Address - Country:US
Mailing Address - Phone:417-887-3855
Mailing Address - Fax:417-887-3857
Practice Address - Street 1:3555 S CULPEPPER CIR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4222
Practice Address - Country:US
Practice Address - Phone:417-887-3855
Practice Address - Fax:417-887-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000172900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF41947Medicare UPIN