National Provider Identifier Database

CANONICO EAR NOSE AND THROAT PC
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

CANONICO EAR, NOSE AND THROAT, P.C.
507 NW ATLANTIC ST
TULLAHOMA, TN37388-3504
Phone: 931-393-4332
Fax: 931-393-2304
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X

* Indicates primary specialty

NPI Profile & details for CANONICO EAR, NOSE AND THROAT, P.C.

NPI Number 1932177805
Legal business name
LBN
CANONICO EAR, NOSE AND THROAT, P.C.
Authorized official TANDIE MOYERS - (OFFICE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 03/08/2006
Last updated 04/20/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • TN Medicaid: 3710667
  • TN Other: 4064287 BLUECROSS BLUESHIELD
  • TN Other: 3710667 RAILROAD MEDICARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for CANONICO EAR, NOSE AND THROAT, P.C.

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