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Organization

THE EAR, NOSE AND THROAT CLINIC AND HEARING CENTER, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS MICHAEL TEDFORD MD (PRESIDENT)
(952) 832-5252
Entity
Organization

Contact information

Practice address
7300 FRANCE AVE S STE 420, EDINA, MN 55435-4504
(952) 832-5252
Mailing address
7300 FRANCE AVE S STE 420, EDINA, MN 55435-4504
(952) 832-5252

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
30533
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
150566
UCARE
01
32G94EA
BLUE CROSS BLUE SHIELD
01
60868
PREFERRED ONE
05
656058000
MN
01
C02994
MEDICARE PTAN
01
DE8379
RAILROAD MEDICARE
Enumeration date
08/17/2006
Last updated
02/18/2016
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