1669579934 NPI number — AUGUSTA EAR NOSE &THROAT SPECIALISTS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669579934 NPI number — AUGUSTA EAR NOSE &THROAT SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA EAR NOSE &THROAT SPECIALISTS, LLC
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:
1669579934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 WOODLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAUNTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24401-2370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-538-5792
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MEDICAL CENTER CIR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
FISHERSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22939-2273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-245-7027
Provider Business Practice Location Address Fax Number:
540-245-7027
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEEFE
Authorized Official First Name:
CAREY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE MANAGER
Authorized Official Telephone Number:
540-538-6792

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  0101043485 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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