Provider Demographics
NPI:1275966889
Name:PROTON THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:PROTON THERAPY CENTER, LLC
Other - Org Name:PROVISION CENTER FOR PROTON THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-684-2606
Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2456
Mailing Address - Country:US
Mailing Address - Phone:865-342-4518
Mailing Address - Fax:865-321-4555
Practice Address - Street 1:6450 PROVISION CARES WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2544
Practice Address - Country:US
Practice Address - Phone:865-862-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation