Provider Demographics
NPI:1952462475
Name:STEWART EAR NOSE AND THROAT CENTER
Entity Type:Organization
Organization Name:STEWART EAR NOSE AND THROAT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-615-2503
Mailing Address - Street 1:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1984
Mailing Address - Country:US
Mailing Address - Phone:662-323-3684
Mailing Address - Fax:662-323-3647
Practice Address - Street 1:300 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2156
Practice Address - Country:US
Practice Address - Phone:662-323-3684
Practice Address - Fax:662-323-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-269261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04826802Medicaid
MSC03206Medicare ID - Type UnspecifiedCLINIC GROUP