Organization
CANONICO EAR, NOSE AND THROAT, P.C.
Active
Organization
CANONICO EAR, NOSE AND THROAT, P.C.
Active
Other names
Ear, Nose and Throat Associates of Middle Tennessee, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
TANDIE L MOYERS (OFFICE MANAGER)
(931) 684-3504
Entity
Organization
Contact information
Practice address
507 NW ATLANTIC ST, TULLAHOMA, TN 37388-3504
(931) 393-4332
(931) 393-2304
Mailing address
507 NW ATLANTIC ST, TULLAHOMA, TN 37388-3504
(931) 393-4332
(931) 393-2304
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3710667
RAILROAD MEDICARE
TN
05
—
3710667
—
TN
01
—
4064287
BLUECROSS BLUESHIELD
TN
Enumeration date
03/08/2006
Last updated
04/20/2021
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