Provider Demographics
NPI:1811198393
Name:PRESCOTT EAR NOSE & THROAT PLLC
Entity Type:Organization
Organization Name:PRESCOTT EAR NOSE & THROAT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:STRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-778-9190
Mailing Address - Street 1:1125 W IRON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1623
Mailing Address - Country:US
Mailing Address - Phone:928-778-9190
Mailing Address - Fax:928-776-4031
Practice Address - Street 1:1125 W IRON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1623
Practice Address - Country:US
Practice Address - Phone:928-778-9190
Practice Address - Fax:928-776-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23902Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
AZD00378Medicare UPIN
AZD36559Medicare UPIN
AZH30730Medicare UPIN