Provider Demographics
NPI:1013050970
Name:CENTRAL MO EAR, NOSE, THROAT, & SINUS, P.C.
Entity Type:Organization
Organization Name:CENTRAL MO EAR, NOSE, THROAT, & SINUS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-659-5570
Mailing Address - Street 1:3527 W TRUMAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5902
Mailing Address - Country:US
Mailing Address - Phone:573-659-5570
Mailing Address - Fax:573-659-5577
Practice Address - Street 1:3527 W TRUMAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5902
Practice Address - Country:US
Practice Address - Phone:573-659-5570
Practice Address - Fax:573-659-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR1K87174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504611609Medicaid
MO24321OtherBLUE CROSS BLUE SHIELD
MODG6216OtherRAILROAD MEDICARE
MODG6216OtherRAILROAD MEDICARE