1558305474 NPI number — CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.

Table of content: (NPI 1558305474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558305474 NPI number — CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
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:
1558305474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 GILEAD RD
Provider Second Line Business Mailing Address:
SUITE 344-345
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-7505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-948-6044
Provider Business Mailing Address Fax Number:
704-948-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 GILEAD RD
Provider Second Line Business Practice Location Address:
SUITE 344-345
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-7505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-948-6044
Provider Business Practice Location Address Fax Number:
704-948-6559
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRILL
Authorized Official First Name:
WILLARD
Authorized Official Middle Name:
CARDWELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-322-2183

Provider Taxonomy Codes

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

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

  • Identifier: 890298Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0298Q . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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