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General NPI Number Information
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NPI Number | 1427266147
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Entity Type | Organization
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Legal Business Name | MEADOWCREST ENT AND FACIAL COSMETIC CENTER
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 3360 EMMAUS RD
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City | HARRISONBURG
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State | VA
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Zip | 22801-2685
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Country | US
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Telephone | 540-433-9399
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Fax | 540-433-1395
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Provider Business Mailing Address
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Address Line | 3360 EMMAUS RD
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City | HARRISONBURG
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State | VA
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Zip | 22801-2685
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Country | US
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Telephone | 540-433-9399
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Fax | 540-433-1395
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHARLES WAYNE GATES
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Credential | M.D.
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Telephone | 540-433-9399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101037916
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License Number State | VA
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