Provider Demographics
NPI:1417953845
Name:MEADOWVIEW EAR NOSE AND THROAT SPEC PC
Entity Type:Organization
Organization Name:MEADOWVIEW EAR NOSE AND THROAT SPEC PC
Other - Org Name:MEADOWVIEW ENT SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AYLITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-8155
Mailing Address - Street 1:FIVE SHERIDAN SQUARE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7390
Mailing Address - Country:US
Mailing Address - Phone:423-246-8155
Mailing Address - Fax:423-246-8658
Practice Address - Street 1:FIVE SHERIDAN SQUARE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7390
Practice Address - Country:US
Practice Address - Phone:423-246-8155
Practice Address - Fax:423-246-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941577Medicaid
TN3713921Medicare ID - Type Unspecified
KY65941577Medicaid