Basic Information
| Provider Information | |||||||||
| NPI: | 1356325757 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIRGINIA EAR NOSE & THROAT ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36007 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232358000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 WADSWORTH DR | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232364500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044843700 | ||||||||
| FaxNumber: | 8043206462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE MGMT | ||||||||
| AuthorizedOfficialTelephone: | 8044843700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 089983 | 01 | VA | ANTHEM | OTHER | 737597 | 01 | VA | AETNA | OTHER |