Provider Demographics
NPI:1760780688
Name:LINCOLN EAR NOSE AND THROAT
Entity Type:Organization
Organization Name:LINCOLN EAR NOSE AND THROAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-433-1100
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-433-2909
Mailing Address - Fax:931-438-7447
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-433-2909
Practice Address - Fax:931-438-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41519207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty