Provider Demographics
NPI:1255405460
Name:CENTRAL COAST HEAD & NECK SURGEONS A M C INC
Entity type:Organization
Organization Name:CENTRAL COAST HEAD & NECK SURGEONS A M C INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-775-0205
Mailing Address - Street 1:1095 LOS PALOS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3916
Mailing Address - Country:US
Mailing Address - Phone:831-775-0205
Mailing Address - Fax:831-775-0206
Practice Address - Street 1:1095 LOS PALOS DRIVE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3916
Practice Address - Country:US
Practice Address - Phone:831-775-0205
Practice Address - Fax:831-775-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN7995OtherMEDICARE RAILROAD
CACT0518OtherMEDICARE RAILROAD
CAGR0066352Medicaid
CAGR0066351Medicaid
CAGR0066350Medicaid
CAZZZ14379ZMedicare PIN
CAZZZ14382ZMedicare PIN
CAGR0066351Medicaid