Provider Demographics
NPI:1699839878
Name:GREENWOOD EAR NOSE AND THROAT ASSOC PA
Entity Type:Organization
Organization Name:GREENWOOD EAR NOSE AND THROAT ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-227-6741
Mailing Address - Street 1:1015 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646
Mailing Address - Country:US
Mailing Address - Phone:864-227-6741
Mailing Address - Fax:864-227-2026
Practice Address - Street 1:1015 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646
Practice Address - Country:US
Practice Address - Phone:864-227-6741
Practice Address - Fax:864-227-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty