Provider Demographics
NPI:1053300194
Name:NEUROSURGERY & SPINE CONSULTANTS OF EAST TENNESSEE PC
Entity Type:Organization
Organization Name:NEUROSURGERY & SPINE CONSULTANTS OF EAST TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HANS
Authorized Official - Last Name:HAUGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-694-0577
Mailing Address - Street 1:9314 PARK WEST BLVD
Mailing Address - Street 2:200 MEDICAL ARTS BLDG
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4330
Mailing Address - Country:US
Mailing Address - Phone:865-694-0577
Mailing Address - Fax:865-694-4720
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:200 MEDICAL ARTS BLDG
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4330
Practice Address - Country:US
Practice Address - Phone:865-694-0577
Practice Address - Fax:865-694-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5388170001Medicare NSC
TN3388514Medicare ID - Type Unspecified