Healthcare Provider Details

I. General information

NPI: 1427266147
Provider Name (Legal Business Name): MEADOWCREST ENT AND FACIAL COSMETIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 EMMAUS RD
HARRISONBURG VA
22801-2685
US

IV. Provider business mailing address

3360 EMMAUS RD
HARRISONBURG VA
22801-2685
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-9399
  • Fax: 540-433-1395
Mailing address:
  • Phone: 540-433-9399
  • Fax: 540-433-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101037916
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES WAYNE GATES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 540-433-9399