Provider Demographics
NPI:1558305474
Name:CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
Entity Type:Organization
Organization Name:CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:CARDWELL
Authorized Official - Last Name:HARRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-2183
Mailing Address - Street 1:10300 GILEAD RD
Mailing Address - Street 2:SUITE 344-345
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7505
Mailing Address - Country:US
Mailing Address - Phone:704-948-6044
Mailing Address - Fax:704-948-6559
Practice Address - Street 1:10300 GILEAD RD
Practice Address - Street 2:SUITE 344-345
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7505
Practice Address - Country:US
Practice Address - Phone:704-948-6044
Practice Address - Fax:704-948-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890298QMedicaid
NC0298QOtherBCBS
NC0298QOtherBCBS