Provider Demographics
NPI:1487051439
Name:CHARLESTON ENT ASSOCIATES LLC
Entity type:Organization
Organization Name:CHARLESTON ENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATENAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-576-2600
Mailing Address - Street 1:1849 SAVAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4726
Mailing Address - Country:US
Mailing Address - Phone:843-766-7103
Mailing Address - Fax:843-302-0260
Practice Address - Street 1:298 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8101
Practice Address - Country:US
Practice Address - Phone:843-766-7103
Practice Address - Fax:843-302-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site