Provider Demographics
NPI:1639197593
Name:OTOLARYNGOLOGY CENTER OF EAST TENNESSEE PC
Entity type:Organization
Organization Name:OTOLARYNGOLOGY CENTER OF EAST TENNESSEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-983-4090
Mailing Address - Street 1:275 CHEROKEE PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5155
Mailing Address - Country:US
Mailing Address - Phone:865-983-4090
Mailing Address - Fax:865-984-2308
Practice Address - Street 1:275 CHEROKEE PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5155
Practice Address - Country:US
Practice Address - Phone:865-983-4090
Practice Address - Fax:865-984-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4145080001Medicare NSC
TN3716193Medicare UPIN