Provider Demographics
NPI:1568595536
Name:ALLEGHANY EAR, NOSE & THROAT PC
Entity Type:Organization
Organization Name:ALLEGHANY EAR, NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STRAUSBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-862-7269
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-0609
Mailing Address - Country:US
Mailing Address - Phone:540-862-7269
Mailing Address - Fax:540-862-3381
Practice Address - Street 1:1 ARH LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-862-7269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005850738Medicaid
WV0101101000Medicaid
VA005850738Medicaid
WV0101101000Medicaid