Provider Demographics
NPI:1386752095
Name:CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
Entity type:Organization
Organization Name:CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:CARDWELL
Authorized Official - Last Name:HARRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-342-3402
Mailing Address - Street 1:256C 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3832
Mailing Address - Country:US
Mailing Address - Phone:828-322-2183
Mailing Address - Fax:828-328-4526
Practice Address - Street 1:135 S SHARON AMITY RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2842
Practice Address - Country:US
Practice Address - Phone:704-342-3402
Practice Address - Fax:704-366-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID