Healthcare Provider Details

I. General information

NPI: 1144305475
Provider Name (Legal Business Name): SAINT BLAISE EAR NOSE AND THROAT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9936 US HIGHWAY 311
ARCHDALE NC
27263-8826
US

IV. Provider business mailing address

9936 US HIGHWAY 311
ARCHDALE NC
27263-8826
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-2765
  • Fax: 336-883-9066
Mailing address:
  • Phone: 336-883-2765
  • Fax: 336-883-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM ARNOLD PINCUS
Title or Position: PRESIDENT
Credential: MD
Phone: 336-883-2765