Healthcare Provider Details

I. General information

NPI: 1699839878
Provider Name (Legal Business Name): GREENWOOD EAR NOSE AND THROAT ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SPRING ST
GREENWOOD SC
29646
US

IV. Provider business mailing address

1015 SPRING ST
GREENWOOD SC
29646
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-6741
  • Fax: 864-227-2026
Mailing address:
  • Phone: 864-227-6741
  • Fax: 864-227-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN R ROST
Title or Position: OWNER
Credential: MD
Phone: 864-227-6741