NPIMap

Organization Active NPI

Ear Nose Throat & Audiology Associates

  • Otolaryngology Physician
  • Rock Hill, SC
National Provider Identifier
1366632655
Registry record updated Aug 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
EAR NOSE THROAT & AUDIOLOGY ASSOCIATES
Practice address
744 Arden LN
Suite 200
Rock Hill, SC 29732-2984
Phone
(803) 328-3686
Fax
(803) 328-9889
NPI assigned
Aug 1, 2007
Last updated
Aug 14, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
EAR NOSE THROAT & AUDIOLOGY ASSOCIATES OF THE CAROLINAS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2015

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

Authorized official

Name
Mr. Leroy Broadnax
Title
Office Manager
Phone
(803) 328-3686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

744 Arden LN
Suite 200
Rock Hill, SC 29732-2984

Mailing address

8334 Pineville Matthews Rd
Suite 103-151
Charlotte, NC 28226-3774
Phone (803) 328-3686

Other identifiers 1

IdentifierTypeStateIssuer
GP4146MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051011000962 SC Part B Supplier - Clinic/Group Practice 3375568009 Receives reassigned benefits from 6 practitioners
Practice locations: West Columbia, SC; Union, SC; Gaffney, SC; Rock Hill, SC

National Provider Directory

National Provider Directory
Tax ID family
Ear Nose Throat Audiology2 organizations share this tax ID, including this one
Part of
Ear Nose Throat Audiolo

Other organizations with this tax ID 1

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

Locations

8334 Pineville Matthews Rd
Ste 103151
Charlotte, NC 28226

720B S Duncan Byp
Unit A
Union, SC 29379
Phone (864) 429-0115

Practitioners & affiliated clinicians

Practitioners 9

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": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439510400000",
    "number": "1366632655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8334 PINEVILLE MATTHEWS RD",
            "address_2": "SUITE 103-151",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282263774",
            "telephone_number": "803-328-3686",
            "fax_number": "803-328-9889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 ARDEN LN",
            "address_2": "SUITE 200",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322984",
            "telephone_number": "803-328-3686",
            "fax_number": "803-328-9889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR NOSE THROAT & AUDIOLOGY ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAR NOSE THROAT & AUDIOLOGY ASSOCIATES OF THE CAROLINAS, P.A.",
        "enumeration_date": "2007-08-01",
        "last_updated": "2015-08-14",
        "status": "A",
        "authorized_official_last_name": "BROADNAX",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "803-328-3686",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4146",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; 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.