Provider Demographics
NPI:1225195712
Name:SOUTHEASTERN EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:SOUTHEASTERN EAR, NOSE & THROAT
Other - Org Name:NASHVILLE ENT AUDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-386-9089
Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-386-9089
Mailing Address - Fax:615-386-2197
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 803
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-386-9089
Practice Address - Fax:615-386-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3967067Medicare ID - Type Unspecified