Provider Demographics
NPI:1033223896
Name:CENTRAL TENNESSEE EAR NOSE & THROAT
Entity Type:Organization
Organization Name:CENTRAL TENNESSEE EAR NOSE & THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-647-1255
Mailing Address - Street 1:787 WEATHERLY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8949
Mailing Address - Country:US
Mailing Address - Phone:931-647-1255
Mailing Address - Fax:931-647-2399
Practice Address - Street 1:787 WEATHERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8949
Practice Address - Country:US
Practice Address - Phone:931-647-1255
Practice Address - Fax:931-647-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6039651OtherBLUECROSS
TN1524504Medicaid
TN621860059OtherTRICARE
TN1524504Medicaid