Provider Demographics
NPI:1255352266
Name:TENNESSEE EAR, NOSE & THROAT CONSULTANTS, PC
Entity type:Organization
Organization Name:TENNESSEE EAR, NOSE & THROAT CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-414-7660
Mailing Address - Street 1:PO BOX 31547
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1547
Mailing Address - Country:US
Mailing Address - Phone:865-693-6065
Mailing Address - Fax:865-531-6325
Practice Address - Street 1:9430 PARK WEST BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4200
Practice Address - Country:US
Practice Address - Phone:865-693-6065
Practice Address - Fax:865-531-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719201Medicare ID - Type Unspecified
TN3719202Medicare ID - Type Unspecified
TN3719200Medicare ID - Type Unspecified