Organization
ENT CAROLINA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE A BYRUM (PRACTICE ADMINISTRATOR)
(704) 868-8400
Entity
Organization
Contact information
Practice address
2520 ABERDEEN BLVD, GASTONIA, NC 28054-0635
(704) 868-8400
(704) 868-8493
Mailing address
2520 ABERDEEN BLVD, GASTONIA, NC 28054-0635
(704) 868-8400
(704) 868-8493
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171M
BLUE CROSS BLUE SHIELD
NC
01
—
0930362
AETNA HEALTHPLAN
NC
05
—
890171M
—
NC
01
—
CA9743
RAILROAD MEDICARE
NC
Enumeration date
09/14/2005
Last updated
01/10/2008
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