Basic Information
Provider Information | |||||||||
NPI: | 1073143632 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TENNESSEE ONCOLOGY PHARMACY DISPENSING | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2004 HAYES ST STE 800 | ||||||||
Address2: |   | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372032659 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153290570 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 300 STONECREST BLVD STE 400 | ||||||||
Address2: |   | ||||||||
City: | SMYRNA | ||||||||
State: | TN | ||||||||
PostalCode: | 371676802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153551770 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2020 | ||||||||
LastUpdateDate: | 01/23/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DOUGLAS | ||||||||
AuthorizedOfficialFirstName: | PATTIE | ||||||||
AuthorizedOfficialMiddleName: | Y | ||||||||
AuthorizedOfficialTitleorPosition: | PAYER RELATIONS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 6155146876 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | TENNESSEE ONCOLOGY PHARMACY DISPENSING | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/23/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X |   |   | Y |   | Suppliers | Non-Pharmacy Dispensing Site |   |
No ID Information.