South Lake Ears Nose & Throat PA

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

9701107 Issued in NC

Legal business name

SOUTH LAKE EARS NOSE & THROAT PA

Practice address

9710 Sam Furr Rd Unit D
Huntersville, NC 28078-4928

Phone

(704) 896-1909

Fax

(704) 896-1926

NPI assigned

Feb 27, 2012

Last updated

Feb 27, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stan D Phillips, MDNPI 1124034202

Title

Owner

Phone

(704) 896-1909

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 4

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.

• Stan D. Phillips, M.D

  • Otolaryngology Physician
  • Huntersville, NC
  • NPI 1124034202
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Brian Slater, AU. D.

  • Audiologist
  • Huntersville, NC
  • NPI 1417579855
  Medicare reassignment Care Compare group NPD
• Ashley Light, AU.D.

  • Audiologist
  • Roanoke, VA
  • NPI 1689231847

  NC

  Medicare reassignment Care Compare group NPD
• Kelly Clarke Knolhoff, AU.D.

  • Audiologist
  • Huntersville, NC
  • NPI 1255535100
  NPD (past)

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1154695872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9710 SAM FURR RD UNIT D",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280784928",
            "telephone_number": "704-896-1909",
            "fax_number": "704-896-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9710 SAM FURR RD UNIT D",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280784928",
            "telephone_number": "704-896-1909",
            "fax_number": "704-896-1926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE EARS NOSE & THROAT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "STAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-896-1909",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9701107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891108A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Solutions Behavioral Health Services PLLC
• Erin Somerville, MA, BCBA
• Sona Medspa Physician Group, PLLC (Sona Dermatology & Medspa)
• Carolyn A. Souders, LCSW
• South Lake Audiology, Inc. (Birkdale Audiology)
• South Lake Pediatrics (Atrium Health Levine Children's South Lake Pediatrics)
• Southeastern Seating and Mobility Consulting LLC (Southeastern Seating and Mobility)
• Southern Oncology Specialists, PLLC
• Southern Oncology Specialists, PLLC
• Southlake Family and Cosmetic Dentistry

• Otolaryngology Physician in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.