Healthcare Provider Details

I. General information

NPI: 1730292376
Provider Name (Legal Business Name): FLORENCE EARS, NOSE & THROAT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 MCLURE CT
FLORENCE SC
29505-6174
US

IV. Provider business mailing address

1521 MCLURE CT
FLORENCE SC
29505-6174
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-2900
  • Fax: 843-629-8122
Mailing address:
  • Phone: 843-665-2900
  • Fax: 843-629-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number19910
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number19910
License Number StateSC

VIII. Authorized Official

Name: HOWARD A FARRELL
Title or Position: PHYSICIAN/OWNER
Credential:
Phone: 843-665-2900