Salem Pediatric Ear and Airway Center, PLLC

Primary specialty

Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X

License

2006-00303 Issued in NC

Legal business name

SALEM PEDIATRIC EAR AND AIRWAY CENTER, PLLC

Practice address

615 Saint George Square CT
Suite 364
Winston Salem, NC 27103-1356

Phone

(336) 245-4972

Fax

(336) 450-1676

NPI assigned

Mar 8, 2016

Organization subpart

No

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

Authorized official

Name

Adele Karen Evans, MD

Title

Member Manager

Phone

(919) 699-2269

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457395200000",
    "number": "1588025381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SAINT GEORGE SQUARE CT",
            "address_2": "SUITE 364",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031356",
            "telephone_number": "336-245-4972",
            "fax_number": "336-450-1676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SAINT GEORGE SQUARE CT",
            "address_2": "SUITE 364",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031356",
            "telephone_number": "336-245-4972",
            "fax_number": "336-450-1676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM PEDIATRIC EAR AND AIRWAY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-08",
        "last_updated": "2016-03-08",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ADELE",
        "authorized_official_middle_name": "KAREN",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "919-699-2269",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "NC",
            "license": "2006-00303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760414866",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Salem Kidney Center of Wake Forest University (Salem Kidney Center)
• Salem Medical Supply Inc
• Salem Mental Health Associates PLLC
• Salem Neurological Center, P.a.
• Salem Optical Outlet (Salem Optical Company)
• Salem Physical Therapy and Sports Rehab
• Salem Plastic Surgery Inc
• Salem Psychiatric Assoc
• Salem Rheumatology PA
• Salem Speech & Language Services, Inc.

• Pediatric Otolaryngology Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Pediatric Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; 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.