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General NPI Number Information
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NPI Number | 1962828723
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Entity Type | Organization
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Legal Business Name | WYTHE EAR, NOSE, & THROAT, P.C.
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 1787 W LEE HWY
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1437
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Country | US
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Telephone | 276-227-0922
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Fax | 276-227-0925
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Provider Business Mailing Address
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Address Line | 1787 W LEE HWY
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1437
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Country | US
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Telephone | 276-227-0922
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Fax | 276-227-0925
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENETH ROGOTZKE
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Credential | DO
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Telephone | 276-227-0922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0102203300
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License Number State | VA
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