Provider Demographics
NPI:1467552216
Name:EAST TENNESSEE EAR, NOSE & THROAT SPECIALISTS, PC
Entity Type:Organization
Organization Name:EAST TENNESSEE EAR, NOSE & THROAT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-483-2288
Mailing Address - Street 1:800 OAK RIDGE TURNPIKE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830
Mailing Address - Country:US
Mailing Address - Phone:865-483-2288
Mailing Address - Fax:865-482-4400
Practice Address - Street 1:800 OAK RIDGE TURNPIKE
Practice Address - Street 2:SUITE C-100
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-483-2288
Practice Address - Fax:865-482-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904229Medicaid
TN3373518Medicaid