Provider Demographics
NPI:1730365958
Name:ARIZONA EAR NOSE AND THROAT PHYSICIANS PLLC
Entity type:Organization
Organization Name:ARIZONA EAR NOSE AND THROAT PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELEONORA
Authorized Official - Middle Name:KAZIMIERA
Authorized Official - Last Name:TYSIAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-214-0308
Mailing Address - Street 1:14510 W SHUMWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5815
Mailing Address - Country:US
Mailing Address - Phone:623-975-1660
Mailing Address - Fax:623-584-4282
Practice Address - Street 1:14510 W SHUMWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5815
Practice Address - Country:US
Practice Address - Phone:623-975-1660
Practice Address - Fax:623-584-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24954235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ40016859OtherRRB
AZ=========OtherHUMANA
AZ=========OtherSUN HEALTH CORPORATION
AZ=========OtherBLUE CROSS BLUE SHIELD
AZ=========OtherSECURE HORIZONS
AZ=========OtherSCHALLER ANDERSON HEALTH
AZ=========OtherPACIFICARE
AZ=========OtherSCHALLER ANDERSON HEALTH