Provider Demographics
NPI:1851354260
Name:CAPE FEAR OTOLARYNGOLOGY, PA
Entity Type:Organization
Organization Name:CAPE FEAR OTOLARYNGOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMELSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-323-9222
Mailing Address - Street 1:2053 VALLEYGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-323-9222
Mailing Address - Fax:910-221-9220
Practice Address - Street 1:2053 VALLEYGATE DRIVE SUITE 101
Practice Address - Street 2:FAYETTEVILLE
Practice Address - City:CUMBERLAND
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-323-9222
Practice Address - Fax:910-223-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016WNOtherBCBS OF NC PROVIDER #
NC5906259Medicaid
NC016WNOtherBCBS OF NC PROVIDER #