Basic Information
| Provider Information | |||||||||
| NPI: | 1861432171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WACO OTOLARYNGOLOGY ASSOCIATES | ||||||||
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| OtherOrganizationName: | WACO EAR, NOSE & THROAT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W HIGHWAY 6 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767105575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547767744 | ||||||||
| FaxNumber: | 2547519211 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W HIGHWAY 6 | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767105575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547767744 | ||||||||
| FaxNumber: | 2547519211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 09/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEADMON | ||||||||
| AuthorizedOfficialFirstName: | KIRK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2547767744 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.