Provider Demographics
NPI:1063509354
Name:ONCOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:ONCOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOVALIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-425-6250
Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 607
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-668-5335
Mailing Address - Fax:731-668-6670
Practice Address - Street 1:708 W FOREST AVE
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3901
Practice Address - Country:US
Practice Address - Phone:731-425-6250
Practice Address - Fax:731-425-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN024422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073988Medicaid
TNF33187Medicare UPIN
TN3073988Medicaid