# EAR NOSE THROAT MEDICAL SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407490105
- **Authorized official:** KATHLEEN BURK (DESIGNATED OFFICIAL)
- **Authorized official phone:** (314) 541-6838

## Contact information

- **Practice address:** 226 S WOODS MILL RD STE 44W, CHESTERFIELD, MO 63017-3442
- **Practice address phone:** (314) 447-4995
- **Practice address fax:** (314) 682-6093
- **Mailing address:** 1324 CLARKSON CLAYTON CTR STE 301, ELLISVILLE, MO 63011-2145
- **Mailing address phone:** (314) 541-6838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/05/2019
- **Last updated:** 10/03/2022