Basic Information
| Provider Information | |||||||||
| NPI: | 1619522133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE ONCOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HAYES STREET | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153290570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4488 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159864330 | ||||||||
| FaxNumber: | 6155504320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | DOUGLAS | ||||||||
| AuthorizedOfficialFirstName: | PATTIE | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PAYER RELATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6155146876 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | Q051649 | 05 | TN | MEDICAID |