Provider Demographics
NPI:1407914245
Name:TUSCALOOSA EAR NOSE & THROAT CENTER PC
Entity Type:Organization
Organization Name:TUSCALOOSA EAR NOSE & THROAT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLISLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:205-758-9041
Mailing Address - Street 1:1300 MCFARLAND BLVD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2252
Mailing Address - Country:US
Mailing Address - Phone:205-758-9041
Mailing Address - Fax:205-345-8328
Practice Address - Street 1:1300 MCFARLAND BLVD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2252
Practice Address - Country:US
Practice Address - Phone:205-758-9041
Practice Address - Fax:205-345-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3702207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC71240Medicare UPIN
ALG63357Medicare UPIN
ALC71281Medicare UPIN
ALG90345Medicare UPIN
ALG02748Medicare UPIN
ALC71310Medicare UPIN