Provider Demographics
NPI:1679645451
Name:RUTHERFORD EAR NOSE & THROAT PA
Entity Type:Organization
Organization Name:RUTHERFORD EAR NOSE & THROAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-286-0632
Mailing Address - Street 1:175 TRYON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3036
Mailing Address - Country:US
Mailing Address - Phone:828-286-0632
Mailing Address - Fax:828-286-5644
Practice Address - Street 1:175 TRYON RD
Practice Address - Street 2:SUITE A
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3036
Practice Address - Country:US
Practice Address - Phone:828-286-0632
Practice Address - Fax:828-286-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35330207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639269665OtherNPI
NC890221RMedicaid
NC217335AMedicare PIN
1639269665OtherNPI