Provider Demographics
NPI:1942228655
Name:EAST ALABAMA EAR, NOSE, & THROAT, PC
Entity Type:Organization
Organization Name:EAST ALABAMA EAR, NOSE, & THROAT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-705-0012
Mailing Address - Street 1:1965 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5403
Mailing Address - Country:US
Mailing Address - Phone:334-705-0012
Mailing Address - Fax:334-705-0378
Practice Address - Street 1:1965 1ST AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5403
Practice Address - Country:US
Practice Address - Phone:334-705-0012
Practice Address - Fax:334-705-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17818207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1851321053OtherNPI FOR DR. BLYTHE
AL1255363008OtherNPI FOR DR. STILES
AL1740214626OtherNPI FOR DR. WHATLEY
AL529402350Medicaid
ALF71420Medicare UPIN
AL529402350Medicaid