Provider Demographics
NPI:1730292376
Name:FLORENCE EARS, NOSE & THROAT, PC
Entity type:Organization
Organization Name:FLORENCE EARS, NOSE & THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-665-2900
Mailing Address - Street 1:1521 MCLURE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6174
Mailing Address - Country:US
Mailing Address - Phone:843-665-2900
Mailing Address - Fax:843-629-8122
Practice Address - Street 1:1521 MCLURE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6174
Practice Address - Country:US
Practice Address - Phone:843-665-2900
Practice Address - Fax:843-629-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19910174400000X, 207Y00000X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3614Medicaid
SCF80732Medicare UPIN
SCGP3614Medicaid
SCI51920Medicare UPIN