Healthcare Provider Details

I. General information

NPI: 1194921833
Provider Name (Legal Business Name): WILLIAM C EARLES CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR SUITE 104
MARTINSVILLE VA
24112-1945
US

IV. Provider business mailing address

315 HOSPITAL DR SUITE 104
MARTINSVILLE VA
24112-1945
US

V. Phone/Fax

Practice location:
  • Phone: 276-634-5690
  • Fax: 276-634-5691
Mailing address:
  • Phone: 276-634-5690
  • Fax: 276-634-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: