Premier Ear, Nose and Throat Surgeons, LTD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

PREMIER EAR, NOSE AND THROAT SURGEONS, LTD

Practice address

9250 N 3Rd St
Ste. 3025
Phoenix, AZ 85020-2412

Phone

(602) 678-5001

Fax

(602) 678-4787

NPI assigned

Apr 24, 2007

Last updated

Jul 30, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Edward Kelly, M.D.

Title

President

Phone

(602) 678-5001

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Valley Ear, Nose and Throat Surgeons Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jonathan J Wiggenhorn, D.O.

  • Facial Plastic Surgery Physician
  • Goodyear, AZ
  • NPI 1417983230

  Otolaryngology

  NPD (past)
• Rachel Cornwell, AU.D.

  • Audiologist
  • NPI 1598913543
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280448000000",
    "number": "1265651947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 N 3RD ST",
            "address_2": "STE. 3025",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202412",
            "telephone_number": "602-678-5001",
            "fax_number": "602-678-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 N 3RD ST",
            "address_2": "STE. 3025",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850202412",
            "telephone_number": "602-678-5001",
            "fax_number": "602-678-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EAR, NOSE AND THROAT SURGEONS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2010-07-30",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-678-5001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "755879",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364935",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Ear, Nose and Throat Surgeons",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Otolaryngology Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Otolaryngology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.