Basic Information
| Provider Information | |||||||||
| NPI: | 1700856069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENNYSON | ||||||||
| FirstName: | HEATH | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9097 E DESERT COVE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802738503 | ||||||||
| FaxNumber: | 4802149929 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 N SILVERBELL RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465135 | ||||||||
| FaxNumber: | 7404465982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35.120409 | OH | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 1057676A | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 49866 | AZ | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 970673 | 05 | AZ | MEDICAID | 0078122 | 05 | OH | MEDICAID | 3810024975 | 05 | WV | MEDICAID |