Provider Demographics
NPI:1083784839
Name:CROSSVILLE MEDICAL ONCOLOGY PC
Entity Type:Organization
Organization Name:CROSSVILLE MEDICAL ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-707-8808
Mailing Address - Street 1:49 CLEVELAND ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-9716
Mailing Address - Country:US
Mailing Address - Phone:931-707-8808
Mailing Address - Fax:931-707-2736
Practice Address - Street 1:49 CLEVELAND ST
Practice Address - Street 2:SUITE 340
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-9716
Practice Address - Country:US
Practice Address - Phone:931-707-8808
Practice Address - Fax:931-707-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377826Medicare PIN