Provider Demographics
NPI:1467664037
Name:EAST TENNESSEE EAR, NOSE & THROAT SPECIALISTS, PC
Entity Type:Organization
Organization Name:EAST TENNESSEE EAR, NOSE & THROAT SPECIALISTS, PC
Other - Org Name:EAST TENNESSEE OTOLARYNOLOGY HEAD AND NECK SURGERY CENTER
Other - Org Type:Former Legal Business Name
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 TPKE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-483-2288
Mailing Address - Fax:865-482-4400
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-523-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
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
KY65904229Medicaid