Provider Demographics
NPI:1487847802
Name:MIDDLE TENNESSEE RADIATION ONCOLOGY SERVICES, PC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE RADIATION ONCOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-768-2855
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:STE 155
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-768-2855
Mailing Address - Fax:615-768-2856
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:STE 155
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-768-2855
Practice Address - Fax:615-768-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0101OtherAMERICHOICE
TN10082401OtherAMERIGROUP
TN3715295OtherTNCARE
TN3715295OtherTNCARE