Provider Demographics
NPI:1831125574
Name:SALISBURY EAR,NOSE & THROAT CLINIC, P.A.
Entity Type:Organization
Organization Name:SALISBURY EAR,NOSE & THROAT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-637-3344
Mailing Address - Street 1:315 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3346
Mailing Address - Country:US
Mailing Address - Phone:704-637-3344
Mailing Address - Fax:704-637-0118
Practice Address - Street 1:315 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3346
Practice Address - Country:US
Practice Address - Phone:704-637-3344
Practice Address - Fax:704-637-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17741207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902606Medicaid
NC02606OtherBLUE CROSS
NCCA9401OtherRR MEDICARE
NCCA9401OtherRR MEDICARE
NC0552Medicare PIN