Provider Demographics
NPI:1922033448
Name:CAROLINA ENT SPECIALISTS, PA
Entity Type:Organization
Organization Name:CAROLINA ENT SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHIKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-782-2166
Mailing Address - Street 1:1085 NE GATEWAY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2406
Mailing Address - Country:US
Mailing Address - Phone:704-782-2166
Mailing Address - Fax:704-782-2533
Practice Address - Street 1:1085 NE GATEWAY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-782-2166
Practice Address - Fax:704-782-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890112HMedicaid
NC2310578Medicare ID - Type Unspecified