Provider Demographics
NPI:1770790214
Name:JACKSON EAR, NOSE AND THROAT PA
Entity type:Organization
Organization Name:JACKSON EAR, NOSE AND THROAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-352-7655
Mailing Address - Street 1:1421 N STATE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1658
Mailing Address - Country:US
Mailing Address - Phone:601-352-7655
Mailing Address - Fax:601-352-7658
Practice Address - Street 1:1421 N STATE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1658
Practice Address - Country:US
Practice Address - Phone:601-352-7655
Practice Address - Fax:601-352-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07717207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS587095012AOtherBCBS OF MS
MS040014450OtherRAILROAD MEDICARE
MS00115212Medicaid
MSD00940Medicare UPIN
MS040000010Medicare ID - Type UnspecifiedMEDICARE