Healthcare Provider Details

I. General information

NPI: 1104092238
Provider Name (Legal Business Name): VIRGINIA EAR NOSE AND THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 308
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

PO BOX 36007
RICHMOND VA
23235-8000
US

V. Phone/Fax

Practice location:
  • Phone: 804-484-3700
  • Fax: 804-320-6462
Mailing address:
  • Phone: 804-484-3700
  • Fax: 804-320-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY T WEST
Title or Position: DIRECTOR OF REVENUE CYCLE MGMT
Credential:
Phone: 804-484-3702