NPIMap

Organization Active NPI

Southside Head N Neck Surgery Professional Corp

Doing business as Southside Ear, Nose & Throat

  • Otolaryngology Physician
  • Colonial Heights, VA
National Provider Identifier
1194803338
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
0101036702 Issued in VA
Legal business name
SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP
Doing business as
Southside Ear, Nose & Throat
Practice address
930 South Ave.
Suite 4B
Colonial Heights, VA 23834
Phone
(804) 504-0530
Fax
(804) 504-0532
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2014

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

Authorized official

Name
David Cangcuesta, M.D.NPI 1194786251
Title
Physician/Owner
Phone
(804) 337-1110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 0101036702 VA Primary

Addresses

Primary practice location

930 South Ave.
Suite 4B
Colonial Heights, VA 23834

Mailing address

930 South Ave.
Suite 4B
Colonial Heights, VA 23834
Phone (804) 504-0530

Other identifiers 4

IdentifierTypeStateIssuer
040009007OtherVAMEDICARE RAILROAD
P00002082OtherVAMEDICARE RAILROAD
006555055OtherVAMEDICARE RAILROAD
P00002088OtherVAMEDICARE RAILROAD

Other names 1

  • Southside Ear, Nose & Throat Doing business as

National Provider Directory

National Provider Directory

Locations

930 South Ave
Ste 4B
Colonial Hgts, VA 23834
Phone (804) 504-0530

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1194803338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 SOUTH AVE.",
            "address_2": "SUITE 4B",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "23834",
            "telephone_number": "804-504-0530",
            "fax_number": "804-504-0532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SOUTH AVE.",
            "address_2": "SUITE 4B",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "23834",
            "telephone_number": "804-504-0530",
            "fax_number": "804-504-0532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "CANGCUESTA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "804-337-1110",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "VA",
            "license": "0101036702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "040009007",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00002082",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "006555055",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00002088",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Ear, Nose & Throat",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colonial Heights, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; 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.