1033430061 NPI number — GARMAN EAR NOSE AND THROAT CENTER PC

Table of content: (NPI 1033430061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033430061 NPI number — GARMAN EAR NOSE AND THROAT CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARMAN EAR NOSE AND THROAT CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033430061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4002 BEESTON HILL MEDICAL CENTER
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-778-0730
Provider Business Mailing Address Fax Number:
340-713-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1AA BEESTON HILL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
SUITE9
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-778-0730
Provider Business Practice Location Address Fax Number:
340-713-0733
Provider Enumeration Date:
06/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARMAN
Authorized Official First Name:
GUY
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
340-778-0730

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  1602 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1306879309 . This is a "PERSOAL NPI" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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