Provider Demographics
NPI:1962828723
Name:WYTHE EAR, NOSE, & THROAT, P.C.
Entity Type:Organization
Organization Name:WYTHE EAR, NOSE, & THROAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-227-0922
Mailing Address - Street 1:1787 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1437
Mailing Address - Country:US
Mailing Address - Phone:276-227-0922
Mailing Address - Fax:276-227-0925
Practice Address - Street 1:1787 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1437
Practice Address - Country:US
Practice Address - Phone:276-227-0922
Practice Address - Fax:276-227-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D25576Medicare UPIN