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DESOTO EAR NOSE &THROAT NPI 1477644045


NPI Information

NPI: 1477644045
Provider Name: DESOTO EAR, NOSE &THROAT
Classification: Otolaryngology - 207Y00000X
Entity Type: Organization
Address:
7164 HACKS CROSS RD STE 106
OLIVE BRANCH, MS
ZIP 38654
Phone: (662) 895-6455
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DESOTO EAR, NOSE &THROAT is an otolaryngology in Olive Branch, MS. The provider is an otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. DESOTO EAR, NOSE &THROAT NPI is 1477644045. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7164 HACKS CROSS RD STE 106
OLIVE BRANCH, MS
ZIP 38654-919
Phone: (662) 895-6455
Fax: (662) 895-6460

The provider's authorized official is Greene Berry Colvin .
The authorized official title is Owner and has the following contact phone number (662) 895-6455.

The enumeration date for this NPI number is 9/27/2006 and was last updated on 6/9/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Y00000XOtolaryngologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
109016063MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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