NPIMap

Organization Active NPI

Lock Haven Ear Nose & Throat PC

  • Otolaryngology Physician
  • Lock Haven, PA
National Provider Identifier
1346396363
Registry record updated Nov 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD026474E Issued in PA
Legal business name
LOCK HAVEN EAR NOSE & THROAT PC
Practice address
401 High Street
Lock Haven, PA 17745-0117
Phone
(570) 748-6777
Fax
(570) 748-0110
NPI assigned
Jan 25, 2007
Last updated
Nov 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2008

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

Authorized official

Name
Dr. Charles Kenneth Foulsham II, MDNPI 1972669612
Title
President
Phone
(570) 748-6777

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 Physician 207Y00000X MD026474E PA Primary

Addresses

Primary practice location

401 High Street
Lock Haven, PA 17745-0117

Mailing address

PO Box 117
401 High Street
Lock Haven, PA 17745-0117
Phone (570) 748-6777

Other identifiers 4

IdentifierTypeStateIssuer
001030532MedicaidPA
058467OtherPABLUE CROSS BLUE SHIELD
186393205OtherPAGEISINGER HEALTH PLAN
1943384OtherPAPENNSYLVANIA BLUE SHIELD

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": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1346396363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117",
            "address_2": "401 HIGH STREET",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177450117",
            "telephone_number": "570-748-6777",
            "fax_number": "570-748-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 HIGH STREET",
            "city": "LOCK HAVEN",
            "state": "PA",
            "postal_code": "177450117",
            "telephone_number": "570-748-6777",
            "fax_number": "570-748-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCK HAVEN EAR NOSE & THROAT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "FOULSHAM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-748-6777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD026474E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001030532",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "058467",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "186393205",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA BLUE SHIELD",
            "identifier": "1943384",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lock Haven, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.