Provider Demographics
NPI:1720437155
Name:CENTRAL PARK EAR NOSE & THROAT LLP FORT WORTH
Entity Type:Organization
Organization Name:CENTRAL PARK EAR NOSE & THROAT LLP FORT WORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-6336
Mailing Address - Street 1:409 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2069
Mailing Address - Country:US
Mailing Address - Phone:817-261-9191
Mailing Address - Fax:817-784-8301
Practice Address - Street 1:800 8TH AVE STE 618
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2605
Practice Address - Country:US
Practice Address - Phone:817-335-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL PARK EAR NOSE & THROAT LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty