Provider Demographics
NPI:1821126533
Name:ENT ASSOCIATES
Entity Type:Organization
Organization Name:ENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-623-8288
Mailing Address - Street 1:518 S VAN BUREN RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5033
Mailing Address - Country:US
Mailing Address - Phone:336-623-8288
Mailing Address - Fax:
Practice Address - Street 1:518 S VAN BUREN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5033
Practice Address - Country:US
Practice Address - Phone:336-623-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC978332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001513Medicaid