Basic Information
| Provider Information | |||||||||
| NPI: | 1619186640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE CANCER SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10988 | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379390988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658620988 | ||||||||
| FaxNumber: | 8655441861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1410 TUSCULUM BLVD | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377454286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236390243 | ||||||||
| FaxNumber: | 4236390628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8656379330 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | DB2744 | 01 | TN | RR MEDICARE GROUP | OTHER | 3725737 | 05 | TN | MEDICAID | 659431440 | 05 | KY | MEDICAID |