Provider Demographics
NPI:1548586035
Name:OAK RIDGE RADIATION ONCOLOGY P LLC
Entity Type:Organization
Organization Name:OAK RIDGE RADIATION ONCOLOGY P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:BRIN
Authorized Official - Last Name:NAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-835-4500
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-0129
Mailing Address - Country:US
Mailing Address - Phone:865-835-4500
Mailing Address - Fax:865-835-4503
Practice Address - Street 1:102 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6402
Practice Address - Country:US
Practice Address - Phone:865-835-4500
Practice Address - Fax:865-835-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000252452085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ032005Medicaid