Provider Demographics
NPI:1376599969
Name:EAR, SINUS AND ALLERGY CENTER
Entity Type:Organization
Organization Name:EAR, SINUS AND ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-438-1930
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0271
Mailing Address - Country:US
Mailing Address - Phone:828-438-1930
Mailing Address - Fax:828-438-1937
Practice Address - Street 1:1190 DREXEL RD
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-9570
Practice Address - Country:US
Practice Address - Phone:828-438-1930
Practice Address - Fax:828-438-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0178FOtherBCBS
NC7947051Medicaid
NC1790757748OtherNPI INDIVIDUAL
NC7947051Medicaid
NCE78859Medicare UPIN