Provider Demographics
NPI:1821423112
Name:ENSPHERE RESOURCES, LLC
Entity Type:Organization
Organization Name:ENSPHERE RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUDELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-787-9153
Mailing Address - Street 1:403 LAKEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 RIVERSIDE DR
Practice Address - Street 2:SUITE B275
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2550
Practice Address - Country:US
Practice Address - Phone:478-787-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty