SOUTH LAKE EARS NOSE & THROAT PA (NPI# 1154695872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154695872 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE EARS NOSE & THROAT PA |
| Practice Address |
9710 Sam Furr Rd Unit D Huntersville NC 28078-4928 |
| Practice Telephone | 7048961909 |
| Practice Fax Number | 7048961926 |
| Mailing Telephone | 7048961909 |
| Mailing Fax Number | 7048961926 |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |
| Authorized Official Name | STAN D PHILLIPS (OWNER) |
| Authorized Official Telephone | 7048961909 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 9701107 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 891108A | 05 |
| Street Address |
9710 SAM FURR RD UNIT D |
| City | HUNTERSVILLE |
| State | NC |
| Zip Code | 28078-4928 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417579855 | Michael Brian Slater | Audiologist | 9710 Sam Furr Rd Unit D, Huntersville, NC 28078-4928 | 2020-05-08 |
| 1538601562 | Margaret Jeanne Koester | Audiologist | 9710 Sam Furr Rd Unit D, Huntersville, NC 28078-4928 | 2016-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538787718 | John M. Bakarich, Dds, Pllc | Dentist | 15810 Northcross Drive, Suite A, Huntersville, NC 28078 | 2020-07-14 |
| 1316587082 | Blake Allen Klessig | Chiropractor | 8936 Northpointe Executive Park Dr, Suite 195, Huntersville, NC 28078 | 2020-01-10 |
| 1922644830 | Steven James Underwood | Physical Therapist | Aldersgate Ccrc, 3800 Shamrock Drive, Charlotte, NC 28078 | 2019-11-26 |
| 1851856306 | Jessica Runnion | Behavior Technician | 14625 Reese Blvd, Apartment 208, Huntersville, NC 28078 | 2019-02-08 |
| 1568935401 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 111 Commerce Centre Drive, Suite 305, Huntersville, NC 28078 | 2019-01-03 |
| 1932691763 | Shakira Grier | Massage Therapist | 15905 Brookway Drive, Ste 4202, Huntersville, NC 28078 | 2018-06-06 |
| 1457850596 | Chudney Drew | Counselor | 10224 Hickorywood Hill Ave Ste 201, Huntersville, NC 28078 | 2018-02-05 |
| 1215457122 | Amy Nicole Castongia | Counselor | 10511 Drake Hill Dr, Huntersville, NC 28078 | 2017-06-21 |
| 1457714057 | Robin D Disbro | Registered Nurse | 6216 Colonial Garden Drive, Huntersville, NC 28078 | 2016-03-31 |
| 1144695545 | Huntersville H&r Ops Limited Partnership | Skilled Nursing Facility | 13835 Boren Street, Huntersville, NC 28078 | 2015-12-10 |
| Find all providers in zip 28078 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124034202 | Stan D. Phillips | Otolaryngology | 9710 Sam Furr Rd, Unit D, Huntersville, NC 28078-4977 | 2006-07-31 |
| 1558305474 | Carolina Ear, Nose & Throat Head and Neck Surgery Center, P.a. | Otolaryngology | 10300 Gilead Rd, Suite 344-345, Huntersville, NC 28078-7505 | 2006-06-15 |
| 1730158858 | Todd R Reulbach | Otolaryngology | 10305 Hamptons Park Drive, Suite 201, Huntersville, NC 28078-7217 | 2006-03-14 |
| 1376738955 | Charlotte Eye Ear Nose & Throat Associates, Pa | Otolaryngology | 10305 Hamptons Park Drive, Suite 201, Huntersville, NC 28078-7217 | 2007-09-07 |
| 1780640540 | Mark Turner Weigel | Otolaryngology | 10305 Hamptons Park Drive, Suite 201, Huntersville, NC 28078-7217 | 2006-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528605888 | Inbal Hazkani Bendror | Otolaryngology | 1217 Mossy Glade Cir, Apex, NC 27502-4874 | 2019-12-05 |
| 1174183156 | Queen City Ear Nose and Throat Pllc | Otolaryngology | 8924 Blakeney Professional Dr, Charlotte, NC 28277-6660 | 2019-06-20 |
| 1194244012 | Ethan Staats | Otolaryngology | 391 Heaton Forest Rd, Cashiers, NC 28717 | 2017-09-12 |
| 1528423068 | Charlotte Eye Ear Nose & Throat Associates, Pa | Otolaryngology | 149 Plantation Ridge Drive, Suite 190, Mooresville, NC 28117-9178 | 2015-12-29 |
| 1598151763 | Adam Richard Gigliotti | Otolaryngology | 400 E Stonewall St, Charlotte, NC 28202-3601 | 2015-04-14 |
| 1891112389 | Marshall Snow | Otolaryngology | 109 Piedmont Ave, Winston Salem, NC 27101-3607 | 2014-03-24 |
| 1073937942 | John Monroe | Otolaryngology | 525 Hardee Branch Rd, West End, NC 27376-8961 | 2014-02-12 |
| 1457794893 | Candace Mitchell Waters | Otolaryngology | 170 Manning Drive Campus Box #7070, Chapel Hill, NC 27599-4216 | 2013-04-16 |
| 1457794927 | Amanda Jo Lott Marcellino | Otolaryngology | 1132 N Church St Ste 200, Greensboro, NC 27401 | 2013-04-15 |
| 1710320510 | Nicolas-george Katsantonis | Otolaryngology | 4600 Lake Boone Trl Ste 100, Raleigh, NC 27607 | 2013-04-10 |
| Find all providers with the same taxonomy | ||||
| City | HUNTERSVILLE |
| Zip Code | 28078 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.