Organization · NPI-2

Ear,nose&Throat Head,neck&Sinus Surgery,pc

Clinic/Center · Elizabeth City, NC

NPI number1124214036
StatusActive
Last updated in NPPESOct 20, 2008

Details

NPI
1124214036
Entity type
Organization (NPI-2)
Legal business name
Ear,nose&Throat Head,neck&Sinus Surgery,pc
Organization subpart
No
Enumeration date
Sep 25, 2007
Last updated
Oct 20, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

105 Medical Dr
Elizabeth City, NC 27909-3361

Phone 252-337-7409 · Fax 252-337-7410

Mailing address

105 Medical Dr
Elizabeth City, NC 27909-3361

Phone 252-337-7409 · Fax 252-337-7410

Authorized official

Anthony W Jackson
President Of Corporation
2523377409

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