Provider Demographics
NPI:1629046479
Name:ENT & AUDIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ENT & AUDIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-9003
Mailing Address - Street 1:3820 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8037
Mailing Address - Country:US
Mailing Address - Phone:919-782-9003
Mailing Address - Fax:919-782-9303
Practice Address - Street 1:3820 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8037
Practice Address - Country:US
Practice Address - Phone:919-782-9003
Practice Address - Fax:919-782-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02194OtherBCBS
NC8901957Medicaid
NC38863OtherWELLPATH
NC8901957Medicaid