Provider Demographics
NPI:1487793295
Name:MARICOPA EAR NOSE & THROAT P C
Entity type:Organization
Organization Name:MARICOPA EAR NOSE & THROAT P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-820-1200
Mailing Address - Street 1:2131 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-820-1200
Mailing Address - Fax:480-820-5743
Practice Address - Street 1:2131 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-820-1200
Practice Address - Fax:480-820-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1487793295OtherGROUP NPI
AZZWMBCFMedicare PIN
AZ1487793295OtherGROUP NPI