NPIMap

Organization Active NPI

Ear,Nose&Throat Head,Neck&Sinus Surgery,PC

  • Clinic/Center
  • Elizabeth City, NC
National Provider Identifier
1124214036
Registry record updated Oct 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EAR,NOSE&THROAT HEAD,NECK&SINUS SURGERY,PC
Practice address
105 Medical Dr
Elizabeth City, NC 27909-3361
Phone
(252) 337-7409
Fax
(252) 337-7410
NPI assigned
Sep 25, 2007
Last updated
Oct 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anthony W Jackson Sr., MDNPI 1700987062
Title
President of Corporation
Phone
(252) 337-7409

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

105 Medical Dr
Elizabeth City, NC 27909-3361

Mailing address

105 Medical Dr
Elizabeth City, NC 27909-3361
Phone (252) 337-7409

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1124214036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MEDICAL DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093361",
            "telephone_number": "252-337-7409",
            "fax_number": "252-337-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MEDICAL DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093361",
            "telephone_number": "252-337-7409",
            "fax_number": "252-337-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR,NOSE&THROAT HEAD,NECK&SINUS SURGERY,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "252-337-7409",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.