Provider Demographics
NPI:1457895146
Name:CENTRAL TENNESSEE EAR, NOSE & THROAT HEARING CENTER, LLC
Entity type:Organization
Organization Name:CENTRAL TENNESSEE EAR, NOSE & THROAT HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-647-1255
Mailing Address - Street 1:787 WEATHERLY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8950
Mailing Address - Country:US
Mailing Address - Phone:931-647-1255
Mailing Address - Fax:
Practice Address - Street 1:787 WEATHERLY DR STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8950
Practice Address - Country:US
Practice Address - Phone:931-647-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech