Provider Demographics
NPI:1659489615
Name:ANNISTON EAR, NOSE & THROAT, P.C.
Entity Type:Organization
Organization Name:ANNISTON EAR, NOSE & THROAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HURLBUTT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:256-236-4426
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-236-4426
Mailing Address - Fax:256-238-8830
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-236-4426
Practice Address - Fax:256-238-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528601340Medicaid
CA 0630OtherRAILROAD MEDICARE GRP
CA 0630OtherRAILROAD MEDICARE GRP