Provident Ear Nose and Throat LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

18523 Issued in SC

Legal business name

PROVIDENT EAR NOSE AND THROAT LLC

Practice address

101 S Venture Dr
Greenville, SC 29615-3571

Phone

(864) 232-4846

Fax

(888) 451-9614

NPI assigned

Jun 29, 2009

Organization subpart

No

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

Authorized official

Name

Mr. William Michael Greene, MD

Title

Owner

Phone

(864) 284-9869

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Mary Ellen Kistler, PA-C

  • Medical Physician Assistant
  • Stoneham, MA
  • NPI 1154638260
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1922236074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S VENTURE DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153571",
            "telephone_number": "864-284-9869",
            "fax_number": "864-284-9882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S VENTURE DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153571",
            "telephone_number": "864-232-4846",
            "fax_number": "888-451-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT EAR NOSE AND THROAT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-29",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-284-9869",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "SC",
            "license": "18523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T25960",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prosthetic Care, Inc
• Yianni Protopapadakis
• Provided Care in Home Services, LLC.
• Provided Care in-Home Services LLC
• Providence Home Care LLC
• Jusiah Prowell, MS
• Amanda F. Pruitt, PA-C
• Erin Edwards Pruitt, D.M.D.
• Latasha Pruitt, DNP, FNP-BC
• Mark Cleveland Pruitt, MD

• Otolaryngology Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Otolaryngology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.