Provider Demographics
NPI:1295753010
Name:KANSAS CITY METROPOLITAN EAR NOSE & THROAT PA
Entity type:Organization
Organization Name:KANSAS CITY METROPOLITAN EAR NOSE & THROAT PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-468-8820
Mailing Address - Street 1:9411 N OAK TRAFFICWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155
Mailing Address - Country:US
Mailing Address - Phone:816-468-8820
Mailing Address - Fax:816-468-8898
Practice Address - Street 1:9411 N OAK TRAFFICWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155
Practice Address - Country:US
Practice Address - Phone:816-468-8820
Practice Address - Fax:816-468-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4420000BMedicare ID - Type Unspecified
MO4420000AMedicare ID - Type Unspecified
MO4420000CMedicare ID - Type Unspecified