Organization Name: | EAR,NOSE & THROAT SURGICAL CLINIC OF SOUTH CENTRAL MS |
NPI Number: | 1033312772 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARL WAYNE STEVENS (PRESIDENT) |
Mailing Address: | 306 S 12th Ave Laurel |
State: | MS US |
Postal Code: | 394404327 |
Phone Number: | 6016499706 |
Fax Number: | 6016499708 |
NPI Enumeration Date: | 06/08/2007 |
NPI Last Update Date: | 05/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207YX0905X |
License Number: | 15762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Otolaryngology |
Taxonomy Specialization: | Otolaryngology/Facial Plastic Surgery |
Taxonomy Definition: | An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |