Provider Demographics
NPI:1104136928
Name:METRO EAR NOSE AND THROAT
Entity type:Organization
Organization Name:METRO EAR NOSE AND THROAT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:DELANO
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-742-2194
Mailing Address - Street 1:4104 JUNIUS STREET
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1427
Mailing Address - Country:US
Mailing Address - Phone:214-742-2194
Mailing Address - Fax:214-827-0162
Practice Address - Street 1:4708 ALLIANCE BOULEVARD
Practice Address - Street 2:PAVILLION 1 SUITE#860
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:214-742-2194
Practice Address - Fax:214-827-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X, 332S00000X
TXD9259174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039138501Medicaid
TX1184829707Medicare NSC