Healthcare Provider Details

I. General information

NPI: 1306224035
Provider Name (Legal Business Name): FOOTHILLS ENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ROPER CORNERS CIR
GREENVILLE SC
29615-4833
US

IV. Provider business mailing address

2 ROPER CORNERS CIR
GREENVILLE SC
29615-4833
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7815
  • Fax: 864-234-7846
Mailing address:
  • Phone: 864-234-7815
  • Fax: 864-234-7846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4693
License Number StateSC

VIII. Authorized Official

Name: DR. THOMAS S SELLNER
Title or Position: OWNER
Credential: DO
Phone: 412-779-2845