Provider Demographics
NPI:1952372237
Name:GREENSBORO EAR NOSE & THROAT ASSOCIATES PA
Entity type:Organization
Organization Name:GREENSBORO EAR NOSE & THROAT ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:336-358-4268
Mailing Address - Street 1:1132 N CHURCH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1039
Mailing Address - Country:US
Mailing Address - Phone:336-358-4268
Mailing Address - Fax:336-544-7180
Practice Address - Street 1:1132 N CHURCH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1039
Practice Address - Country:US
Practice Address - Phone:336-358-4268
Practice Address - Fax:336-544-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39952207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01993OtherBLUE CROSS BLUE SHIELD NC
NCCD4175OtherRAILROAD MEDICARE
NC7001505Medicaid
NC8901993Medicaid
NC7001505Medicaid
NC230348Medicare PIN