Provider Demographics
NPI:1689723538
Name:EAR, NOSE & THROAT ASSOCIATES OF FLORENCE
Entity Type:Organization
Organization Name:EAR, NOSE & THROAT ASSOCIATES OF FLORENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUFUS
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-413-2514
Mailing Address - Street 1:800 E CHEVES ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2650
Mailing Address - Country:US
Mailing Address - Phone:843-413-2514
Mailing Address - Fax:843-413-2528
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 480
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-413-2514
Practice Address - Fax:843-413-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2812Medicaid
SCGP2812Medicaid
SC6757Medicare PIN