Provider Demographics
NPI:1275514697
Name:TENNESSEE HDR MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:TENNESSEE HDR MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNOR AND COC
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-859-1337
Mailing Address - Street 1:7551 DANNAHER WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4029
Mailing Address - Country:US
Mailing Address - Phone:865-859-7020
Mailing Address - Fax:865-859-3706
Practice Address - Street 1:7551 DANNAHER WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-7020
Practice Address - Fax:865-859-3706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH PARTNERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X, 261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
3731448Medicare PIN