SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP NPI 1194803338

NPI Information

  • NPI: 1194803338
  • Provider Name: SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP
  • Classification: Otolaryngology - 207Y00000X
  • Entity Type: Organization
  • Doing Business As: SOUTHSIDE EAR, NOSE & THROAT
  • Address: 930 SOUTH AVE.
    SUITE 4B
    COLONIAL HEIGHTS, VA
    ZIP 23834
  • Phone: (804) 504-0530

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NPI Details

SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP is an otolaryngology in Colonial Heights, VA. The provider is 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. SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP NPI is 1194803338. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southside Ear, Nose & Throat.

The provider's business location address is:

930 SOUTH AVE.
SUITE 4B
COLONIAL HEIGHTS, VA
ZIP 23834
Phone: (804) 504-0530
Fax: (804) 504-0532

The provider's authorized official is David Cangcuesta .
The authorized official title is Physician/owner and has the following contact phone number (804) 337-1110.

The enumeration date for this NPI number is 11/2/2006 and was last updated on 7/1/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Y00000XOtolaryngology0101036702VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1040009007OTHERVIRGINIAMEDICARE RAILROAD
2C03320MEDICARE PIN
3P00002082OTHERVIRGINIAMEDICARE RAILROAD
4C03321MEDICARE PIN
5P00002088OTHERVIRGINIAMEDICARE RAILROAD
6006555055OTHERVIRGINIAMEDICARE RAILROAD
7C03320MEDICARE PINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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