Healthcare Provider Details

I. General information

NPI: 1952478752
Provider Name (Legal Business Name): EAR NOSE THROAT HEAD & NECK SURGERY OF HUNTSVILLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WHITESPORT DR SW
HUNTSVILLE AL
35801-6449
US

IV. Provider business mailing address

201 WHITESPORT DR SW
HUNTSVILLE AL
35801-6449
US

V. Phone/Fax

Practice location:
  • Phone: 256-881-5353
  • Fax: 256-881-0712
Mailing address:
  • Phone: 256-881-5353
  • Fax: 256-881-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. STACI KRAUSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 256-881-5353