Provider Demographics
NPI:1386020782
Name:BRIG CENTER FOR CANCER CARE AND SURVIVORSHIP
Entity Type:Organization
Organization Name:BRIG CENTER FOR CANCER CARE AND SURVIVORSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-246-1958
Mailing Address - Street 1:PO BOX 52167
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2167
Mailing Address - Country:US
Mailing Address - Phone:865-246-1958
Mailing Address - Fax:865-246-0955
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2457
Practice Address - Country:US
Practice Address - Phone:865-246-1958
Practice Address - Fax:865-246-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN024684207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G705079Medicaid
TN3077257Medicaid
TN103G705079Medicare PIN
TN3077257Medicaid