MEDICARE: TENNESSEE EAR, NOSE & THROAT CONSULTANTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1255352266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE EAR, NOSE & THROAT CONSULTANTS, PC

Provider Business Mailing Address
First Line	:	PO BOX 31547
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37930-1547
Country	:	US
Telephone Number	:	865-693-6065
Fax Number	:	865-531-6325

Provider Business Practice Location Address
First Line	:	9430 PARK WEST BLVD
Second Line	:	SUITE 330
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4200
Country	:	US
Telephone Number	:	865-693-6065
Fax Number	:	865-531-6325

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	SHANA DOWLEN
Credential	:
Telephone Number	:	865-414-7660

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/18/2023

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