West Tennessee ENT Clinic, P.a.

Key facts

NPI

1720070535

Entity type

Organization (NPI type 2)

Primary specialty

Otolaryngology Physician 207Y00000X

Legal business name

WEST TENNESSEE ENT CLINIC, P.A.

Practice address

619 Skyline Dr
Jackson, TN 38301-3903

Phone

(731) 424-3682

Fax

(731) 423-2714

NPI assigned

Aug 17, 2005

Organization subpart

No

Authorized official

Name

Dr. William Keith Wainscott, M.D.

Title

President

Phone

(731) 424-3682

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720070535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013903",
            "telephone_number": "731-424-3682",
            "fax_number": "731-423-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013903",
            "telephone_number": "731-424-3682",
            "fax_number": "731-423-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST TENNESSEE ENT CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAINSCOTT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "731-424-3682",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3382042",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

• West Tennessee Anesthesia, PC
• West Tennessee Bone and Joint Clinic PC
• West Tennessee Center for Oral and Facial Surgery
• West Tennessee Cerebral Palsy Association
• West Tennessee Dentistry PLLC
• West Tennessee Eye Associates PC
• West Tennessee Hand Center, PLLC
• West Tennessee Healthcare Anesthesia Associates PLLC
• West Tennessee Healthcare Hospitalists Inc
• West Tennessee Hearing & Speech Center, Inc

All providers in Jackson, TN · Otolaryngology Physician in Tennessee