Provider Demographics
NPI:1194921833
Name:EARLES, WILLIAM C (CO)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:EARLES
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:315 HOSPITAL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1945
Mailing Address - Country:US
Mailing Address - Phone:276-634-5690
Mailing Address - Fax:276-634-5691
Practice Address - Street 1:315 HOSPITAL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1945
Practice Address - Country:US
Practice Address - Phone:276-634-5690
Practice Address - Fax:276-634-5691
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795010Medicaid