Provider Demographics
NPI:1972795839
Name:MID-MISSOURI ENT AND FACIAL PLASTIC SURGERY SPECIALISTS INC.
Entity Type:Organization
Organization Name:MID-MISSOURI ENT AND FACIAL PLASTIC SURGERY SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-635-7901
Mailing Address - Street 1:3527 WEST TRUMAN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109
Mailing Address - Country:US
Mailing Address - Phone:573-635-7901
Mailing Address - Fax:573-635-4805
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-348-0826
Practice Address - Fax:573-348-2328
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID MO EAR NOSE THROAT & FACIAL PLASTIC SURGERY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011313Medicare PIN