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General NPI Number Information
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NPI Number | 1710053087
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY ENT CLINIC, P.C.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 323 N MONTGOMERY AVE
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City | SHEFFIELD
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State | AL
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Zip | 35660-2708
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Country | US
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Telephone | 256-381-6673
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Fax | 256-381-8091
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Provider Business Mailing Address
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Address Line | 323 N MONTGOMERY AVE
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City | SHEFFIELD
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State | AL
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Zip | 35660-2708
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Country | US
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Telephone | 256-381-6673
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Fax | 256-381-8091
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH F. LEMASTER
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Credential | M.D.
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Telephone | 256-381-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 11543
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License Number State | AL
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