Provider Demographics
NPI:1902098049
Name:MCINTIRE EAR NOSE & THROAT CENTER
Entity Type:Organization
Organization Name:MCINTIRE EAR NOSE & THROAT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCINTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-623-6767
Mailing Address - Street 1:1331 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1601
Mailing Address - Country:US
Mailing Address - Phone:417-623-6767
Mailing Address - Fax:417-623-3170
Practice Address - Street 1:1331 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1601
Practice Address - Country:US
Practice Address - Phone:417-623-6767
Practice Address - Fax:417-623-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N23207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty