Provider Demographics
NPI:1962699603
Name:HEAD & NECK SURGICAL ASSOC PA
Entity type:Organization
Organization Name:HEAD & NECK SURGICAL ASSOC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-663-5100
Mailing Address - Street 1:6400 PROSPECT
Mailing Address - Street 2:SUITE 346
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132
Mailing Address - Country:US
Mailing Address - Phone:816-333-6996
Mailing Address - Fax:816-333-7061
Practice Address - Street 1:6400 PROSPECT
Practice Address - Street 2:SUITE 346
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-333-6996
Practice Address - Fax:816-333-7061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAD & NECK SURGICAL ASSOC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK800000AMedicare UPIN