Provider Demographics
NPI:1225082019
Name:SPARTANBURG EAR NOSE & THROAT, HEAD & NECK SURGERY PA
Entity Type:Organization
Organization Name:SPARTANBURG EAR NOSE & THROAT, HEAD & NECK SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-582-2900
Mailing Address - Street 1:P.O. BOX 5787
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5787
Mailing Address - Country:US
Mailing Address - Phone:864-582-2900
Mailing Address - Fax:864-582-4991
Practice Address - Street 1:1095 IRON ORE ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2239
Practice Address - Country:US
Practice Address - Phone:864-582-2900
Practice Address - Fax:864-582-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0828Medicaid
SCCB3406OtherRAILROAD MEDICARE
SCPA0828Medicaid