Provider Demographics
NPI:1659882983
Name:HOLLY SPRINGS EAR, NOSE, THROAT & ALLERGY, PC
Entity Type:Organization
Organization Name:HOLLY SPRINGS EAR, NOSE, THROAT & ALLERGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-225-2558
Mailing Address - Street 1:500 HOLLY SPRINGS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6204
Mailing Address - Country:US
Mailing Address - Phone:984-225-2558
Mailing Address - Fax:984-225-2569
Practice Address - Street 1:500 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:984-225-2558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800954207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129FPMedicaid