Provider Demographics
NPI:1164535548
Name:EAST TENNESSE UROLOGY SPECIALISTS
Entity Type:Organization
Organization Name:EAST TENNESSE UROLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEAZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-6919
Mailing Address - Street 1:101 E BLOUNT AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1601
Mailing Address - Country:US
Mailing Address - Phone:865-549-4300
Mailing Address - Fax:865-549-4301
Practice Address - Street 1:101 E BLOUNT AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1632
Practice Address - Country:US
Practice Address - Phone:865-549-4300
Practice Address - Fax:865-549-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725306Medicare ID - Type Unspecified