Basic Information
| Provider Information | |||||||||
| NPI: | 1508146382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAR NOSE & THROAT CENTERS OF TEXAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | 9729841376 | ||||||||
| Practice Location | |||||||||
| Address1: | 4510 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | 9729841376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERGSTROM | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9729841050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | P0462 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.