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Contact Information

LAKE NORMAN EARS NOSE AND THROAT PA
140 GATEWAY BLVD
MOORESVILLE, NC28117
 Phone: 704-664-9638
 Fax: 704-664-1859
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for LAKE NORMAN EARS NOSE AND THROAT PA

NPI Number 1306870902
LBN Legal business name LAKE NORMAN EARS NOSE AND THROAT PA
Authorized official HERBERT WETTREICH - (MD)
Entity Organization
Organization subpart 1 No
Enumeration date 07/10/2006
Last updated 12/09/2009 - About 16 years ago
Identifiers
NC Medicaid 5912716
NC Medicaid 8986676
NC Other 0270K BCBS
NC Other 1781857 UNITED HEALTHCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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