Basic Information
| Provider Information | |||||||||
| NPI: | 1720662513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE CANCER SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E HILL AVE STE 230 | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379152565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658620998 | ||||||||
| FaxNumber: | 8655441861 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 W BROADWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377602602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659345800 | ||||||||
| FaxNumber: | 8659345801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2021 | ||||||||
| LastUpdateDate: | 05/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | JENKINS | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8658620998 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.