Provider Demographics
NPI:1982762589
Name:SOUTHWESTERN VIRGINIA EARS NOSE AND THROAT ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHWESTERN VIRGINIA EARS NOSE AND THROAT ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-639-9023
Mailing Address - Street 1:106 WADSWORTH STREET
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1439
Mailing Address - Country:US
Mailing Address - Phone:540-639-9023
Mailing Address - Fax:540-639-5463
Practice Address - Street 1:106 WADSWORTH STREET
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1439
Practice Address - Country:US
Practice Address - Phone:540-639-9023
Practice Address - Fax:540-639-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06556Medicare PIN