Provider Demographics
NPI:1972504926
Name:NORTH CAROLINA EYE EAR NOSE & THROAT PA
Entity Type:Organization
Organization Name:NORTH CAROLINA EYE EAR NOSE & THROAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTING MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-595-2106
Mailing Address - Street 1:4102 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2122
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:919-595-2186
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2000
Practice Address - Fax:919-595-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNA207W00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901750Medicaid
NC890248AMedicaid
NC01750OtherBCBCNC-OPHTHALMOLOGY
NC0248AOtherBCBSNC-OTOLARYNGOLOGY
NC0248AOtherBCBSNC-OTOLARYNGOLOGY
NC01750OtherBCBCNC-OPHTHALMOLOGY
NC0344620001Medicare ID - Type UnspecifiedDEMERC MEDICARE