NPIMap

Organization Active NPI

Fairmont ENT Associates Inc

  • Otolaryngology Physician
  • Fairmont, WV
National Provider Identifier
1720055882
Registry record updated Oct 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
WV14772 Issued in WV
Legal business name
FAIRMONT ENT ASSOCIATES INC
Practice address
1712 Locust Ave
Fairmont, WV 26554
Phone
(304) 366-6157
Fax
(304) 366-0177
NPI assigned
Mar 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2012

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

Authorized official

Name
Dr. Joedy L Daristotle, MDNPI 1780712752
Title
President
Phone
(304) 366-6157

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X WV14772 WV Primary
Hearing Aid Equipment 332S00000X 398 WV

Addresses

Primary practice location

1712 Locust Ave
Fairmont, WV 26554

Mailing address

1712 Locust Ave
Fairmont, WV 26554
Phone (304) 366-6157

Other identifiers 1

IdentifierTypeStateIssuer
0008704000MedicaidWV

National Provider Directory

National Provider Directory

Locations

1712 Locust Ave
Fairmont, WV 26554
Phone (304) 292-0173

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351209600000",
    "number": "1720055882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "26554",
            "telephone_number": "304-366-6157",
            "fax_number": "304-366-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 LOCUST AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "26554",
            "telephone_number": "304-366-6157",
            "fax_number": "304-366-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRMONT ENT ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2012-10-26",
        "status": "A",
        "authorized_official_last_name": "DARISTOTLE",
        "authorized_official_first_name": "JOEDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-366-6157",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "WV",
            "license": "WV14772",
            "primary": true
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": "WV",
            "license": "398",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008704000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2012; 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.