Basic Information
| Provider Information | |||||||||
| NPI: | 1851424261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CAROLINA EYE EAR NOSE & THROAT PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Practice Location | |||||||||
| Address1: | 4102 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195952000 | ||||||||
| FaxNumber: | 9195952190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9195952106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | NA | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 890248A | 05 | NY | MEDICAID | 0248A | 01 | NC | BCBSNC-OTOLARYNGOLOGY | OTHER |