Provider Demographics
NPI:1689780066
Name:MID-SOUTH EAR, NOSE, AND THROAT, P.C.
Entity Type:Organization
Organization Name:MID-SOUTH EAR, NOSE, AND THROAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-755-5300
Mailing Address - Street 1:8001 CENTERVIEW PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4228
Mailing Address - Country:US
Mailing Address - Phone:901-755-5300
Mailing Address - Fax:901-753-9659
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1785
Practice Address - Country:US
Practice Address - Phone:901-755-5300
Practice Address - Fax:901-753-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719677Medicare PIN