Provider Demographics
NPI:1295832525
Name:VANDERBILT-INGRAM CANCER CENTER AT TENNOVA HEALTHCARE-CLARKSVILLE
Entity Type:Organization
Organization Name:VANDERBILT-INGRAM CANCER CENTER AT TENNOVA HEALTHCARE-CLARKSVILLE
Other - Org Name:VANDERBILT-INGRAM CANCER CENTER AT TENNOVA HEALTHCARE-CLARKSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-6001
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 ALFRED THUN ROAD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-221-0479
Practice Address - Fax:931-221-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733547Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TN3733547Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER