Provider Demographics
NPI:1821177916
Name:MIDWEST SINUS ALLERGY SPECIALISTS, INC
Entity Type:Organization
Organization Name:MIDWEST SINUS ALLERGY SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNINGHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-815-0662
Mailing Address - Street 1:1701 E BROADWAY SUITE 304
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-815-0662
Mailing Address - Fax:573-443-1162
Practice Address - Street 1:1701 E BROADWAY SUITE 304
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-815-0662
Practice Address - Fax:573-443-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505251405Medicaid
MO000013527Medicare ID - Type Unspecified