Provider Demographics
NPI:1154371763
Name:WESTERN CAROLINA EAR NOSE AND THROAT SPECIALISTS, PLLC
Entity type:Organization
Organization Name:WESTERN CAROLINA EAR NOSE AND THROAT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-627-1234
Mailing Address - Street 1:63 HAYWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-4404
Mailing Address - Country:US
Mailing Address - Phone:828-627-1234
Mailing Address - Fax:877-898-3176
Practice Address - Street 1:63 HAYWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-4404
Practice Address - Country:US
Practice Address - Phone:828-627-1234
Practice Address - Fax:828-627-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC112126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014VVOtherBC/BS
NC89014VVMedicaid
NC2332019Medicare ID - Type Unspecified