Provider Demographics
| NPI: | 1255314985 |
|---|---|
| Name: | TEXAS EAR, NOSE & THROAT SPECIALISTS, PLLC |
| Entity type: | Organization |
| Organization Name: | TEXAS EAR, NOSE & THROAT SPECIALISTS, PLLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JOHN |
| Authorized Official - Middle Name: | C |
| Authorized Official - Last Name: | MOORHEAD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 281-890-8908 |
| Mailing Address - Street 1: | 10740 N GESSNER DR |
| Mailing Address - Street 2: | STE 310 |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77064-1240 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 281-897-0416 |
| Mailing Address - Fax: | 281-890-8908 |
| Practice Address - Street 1: | 21216 NORTHWEST FREEWAY |
| Practice Address - Street 2: | STE 310 |
| Practice Address - City: | CYPRESS |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77429-4698 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 281-890-6155 |
| Practice Address - Fax: | 888-905-2348 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-11-28 |
| Last Update Date: | 2025-01-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 207YP0228X, 207YS0012X, 207YS0123X, 207YX0901X, 231H00000X, 237600000X, 363A00000X, 207Y00000X | |
| 207YX0007X, 207YX0602X, 207YX0905X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 207YP0228X | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | Group - Multi-Specialty |
| No | 207YS0012X | Allopathic & Osteopathic Physicians | Otolaryngology | Sleep Medicine | Group - Multi-Specialty |
| No | 207YS0123X | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | Group - Multi-Specialty |
| No | 207YX0007X | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | Group - Multi-Specialty |
| No | 207YX0602X | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngic Allergy | Group - Multi-Specialty |
| No | 207YX0901X | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology | Group - Multi-Specialty |
| No | 207YX0905X | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 109364302 | Medicaid | |
| TX | 081075603 | Medicaid | |
| TX | 109364303 | Medicaid | |
| TX | 081075602 | Medicaid | |
| TX | 081075603 | Medicaid | |
| TX | 109364303 | Medicaid | |
| TX | 0073BH | Medicare PIN | |
| TX | 00333N | Medicare PIN | |
| TX | 109364302 | Medicaid |
