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NPI Code Detail

MEDICARE: LIBERTY CIRCLE EAR NOSE & THROAT INC.

MEDICARE: LIBERTY CIRCLE EAR NOSE & THROAT INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician17624WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306892690
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY CIRCLE EAR NOSE & THROAT INC.
Provider Business Mailing Address
First Line : 96 TOWNSHIP ROAD 369 SUITE 101
Second Line :
City : PROCTORVILLE
State : OH
Zip : 45669
Country : US
Telephone Number : 740-886-9370
Fax Number : 740-886-9374
Provider Business Practice Location Address
First Line : 1340 HAL GREER BLVD
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-3800
Country : US
Telephone Number : 740-886-9370
Fax Number : 740-886-9374
Authorized Official
Title or Position : SOLE MEMBER/MEDICAL DIRECTOR
Name : DR. RICARDO ARTURO ROA
Credential : M.D.
Telephone Number : 740-886-9370
Provider Enumeration Date : 05/26/2006
Last Update Date : 08/22/2020

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Directions to “LIBERTY CIRCLE EAR NOSE & THROAT INC. ” Practice Location

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