Provider Demographics
NPI: | 1306224035 |
---|---|
Name: | FOOTHILLS ENT, INC |
Entity type: | Organization |
Organization Name: | FOOTHILLS ENT, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | THOMAS |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | SELLNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 412-779-2845 |
Mailing Address - Street 1: | 2 ROPER CORNERS CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENVILLE |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29615-4833 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-234-7815 |
Mailing Address - Fax: | 864-234-7846 |
Practice Address - Street 1: | 2 ROPER CORNERS CIR |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29615-4833 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-234-7815 |
Practice Address - Fax: | 864-234-7846 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-14 |
Last Update Date: | 2022-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 4693 | 207Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Single Specialty |