Healthcare Provider Details

I. General information

NPI: 1376599969
Provider Name (Legal Business Name): EAR, SINUS AND ALLERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 DREXEL RD
VALDESE NC
28690-9570
US

IV. Provider business mailing address

PO BOX 271
RUTHERFORD COLLEGE NC
28671-0271
US

V. Phone/Fax

Practice location:
  • Phone: 828-438-1930
  • Fax: 828-438-1937
Mailing address:
  • Phone: 828-438-1930
  • Fax: 828-438-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9300167
License Number StateNC

VIII. Authorized Official

Name: DR. EDWARD BRUCE JONES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 828-438-1930