Provider Demographics
NPI:1356446298
Name:EAST TENNESSEE HEMATOLOGY/ONCOLOGY ASSOC P.C.
Entity Type:Organization
Organization Name:EAST TENNESSEE HEMATOLOGY/ONCOLOGY ASSOC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-926-3611
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3770
Mailing Address - Country:US
Mailing Address - Phone:423-926-3611
Mailing Address - Fax:423-926-3073
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 401
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6008
Practice Address - Country:US
Practice Address - Phone:423-926-3611
Practice Address - Fax:423-926-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QX0200X
TN5883370001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5883370001Medicare NSC
TN3389201Medicare ID - Type UnspecifiedGROUP MEDICARE ID