| Name: | East Alabama Ear, Nose & Throat, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 04 Feb 1994 (31 years ago) |
| Entity Number: | 000-161-919 |
| Register Number: | 000161919 |
| County: | Lee |
| Place of Formation: | Lee County |
| Principal Address: | OPELIKA, AL |
| Registered Office Street Address: | 1965 FIRST AVENUEOPELIKA, AL 36801 |
| Registered Office Street Address ZIP Code: | 36801 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $100 |
Activities
PRACTICE OF MEDICINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942228655 | 2006-07-18 | 2010-02-19 | 1965 1ST AVE, OPELIKA, AL, 368015403, US | 1965 1ST AVE, OPELIKA, AL, 368015403, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-705-0012 |
| Fax | 3347050378 |
Authorized person
| Name | MR. WILLIAM RAYMOND BLYTHE |
| Role | PRESIDENT |
| Phone | 3347050012 |
Taxonomy
| Taxonomy Code | 207Y00000X - Otolaryngology Physician |
| License Number | 17818 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI FOR DR. BLYTHE |
| Number | 1851321053 |
| State | AL |
| Issuer | NPI FOR DR. STILES |
| Number | 1255363008 |
| State | AL |
| Issuer | NPI FOR DR. WHATLEY |
| Number | 1740214626 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529402350 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BLYTHE, WILLIAM R | Agent | 2192 MT VERNON LANEAUBURN, AL 36830 |
| Name | Role |
|---|---|
| STILES, WARREN A MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
