Provider Demographics
NPI:1881712057
Name:EAR NOSE & THROAT SURGICAL GROUP
Entity type:Organization
Organization Name:EAR NOSE & THROAT SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-321-1626
Mailing Address - Street 1:764 LAKELAND DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4617
Mailing Address - Country:US
Mailing Address - Phone:601-982-0611
Mailing Address - Fax:601-321-1647
Practice Address - Street 1:764 LAKELAND DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4617
Practice Address - Country:US
Practice Address - Phone:601-982-0611
Practice Address - Fax:601-321-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00433Medicare ID - Type Unspecified