NPIMap

Organization Active NPI

Liberty Circle Ear Nose & Throat Inc.

  • Otolaryngology Physician
  • Huntington, WV
National Provider Identifier
1306892690
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
17624 Issued in WV
Legal business name
LIBERTY CIRCLE EAR NOSE & THROAT INC.
Practice address
1340 Hal Greer Blvd
Huntington, WV 25701-3800
Phone
(740) 886-9370
Fax
(740) 886-9374
NPI assigned
May 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ricardo Arturo Roa, M.D.NPI 1700821907
Title
Sole Member/Medical Director
Phone
(740) 886-9370

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 17624 WV Primary

Addresses

Primary practice location

1340 Hal Greer Blvd
Huntington, WV 25701-3800

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0954356MedicaidOH
3810004605MedicaidWV

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

1340 Hal Greer Blvd
#H
Huntington, WV 25701
Phone (740) 886-9370

Practitioners & affiliated clinicians

Practitioners 2

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": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306892690",
    "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": "1340 HAL GREER BLVD",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013800",
            "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": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROA",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "ARTURO",
        "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": "WV",
            "license": "17624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0954356",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004605",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.