Provider Demographics
NPI:1104870385
Name:IOWA OTO HEAD AND NECK SPECIALISTS PC
Entity type:Organization
Organization Name:IOWA OTO HEAD AND NECK SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-576-4200
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE N
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-576-4200
Mailing Address - Fax:515-576-3104
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE N
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-576-4200
Practice Address - Fax:515-576-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA268631Medicare ID - Type Unspecified