Provider Demographics
NPI:1669579934
Name:AUGUSTA EAR NOSE &THROAT SPECIALISTS, LLC
Entity type:Organization
Organization Name:AUGUSTA EAR NOSE &THROAT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-538-6792
Mailing Address - Street 1:141 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2370
Mailing Address - Country:US
Mailing Address - Phone:540-538-5792
Mailing Address - Fax:
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7027
Practice Address - Fax:540-245-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043485207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09711Medicare PIN