NPIMap

Organization Active NPI

Liberty Circle Ear Nose & Throat Inc.

  • Otolaryngology Physician
  • Proctorville, OH
National Provider Identifier
1245285758
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35078877R Issued in OH
Legal business name
LIBERTY CIRCLE EAR NOSE & THROAT INC.
Practice address
96 Township Road 369 Suite 101
Proctorville, OH 45669
Phone
(740) 886-9370
Fax
(740) 886-9374
NPI assigned
May 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Dr. Arturo Ricardo Roa, M.D.
Title
Sole Member/Medical Director
Phone
(740) 886-9370

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 35078877R OH Primary

Addresses

Primary practice location

96 Township Road 369 Suite 101
Proctorville, OH 45669

Mailing address

96 Township Road 369 Suite 101
Proctorville, OH 45669
Phone (740) 886-9370

Other identifiers 2

IdentifierTypeStateIssuer
3810004605MedicaidWV
0954356MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Liberty Circle Ear Nose Throat Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

96 Township Road 369
Ste 101
Proctorville, OH 45669
Phone (740) 886-9370

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1245285758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 TOWNSHIP ROAD 369 SUITE 101",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "45669",
            "telephone_number": "740-886-9370",
            "fax_number": "740-886-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 TOWNSHIP ROAD 369 SUITE 101",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "45669",
            "telephone_number": "740-886-9370",
            "fax_number": "740-886-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY CIRCLE EAR NOSE & THROAT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "ROA",
        "authorized_official_first_name": "ARTURO",
        "authorized_official_middle_name": "RICARDO",
        "authorized_official_title_or_position": "SOLE MEMBER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "740-886-9370",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "OH",
            "license": "35078877R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004605",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0954356",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Proctorville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.