Provider Demographics
NPI: | 1619025707 |
---|---|
Name: | TENNESSEE CANCER SPECIALISTS, PLLC |
Entity Type: | Organization |
Organization Name: | TENNESSEE CANCER SPECIALISTS, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF MANAGER PHYSICIAN |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MITCHELL |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 865-637-9330 |
Mailing Address - Street 1: | PO BOX 10988 |
Mailing Address - Street 2: | |
Mailing Address - City: | KNOXVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37939-0988 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 865-862-0998 |
Mailing Address - Fax: | 865-544-1861 |
Practice Address - Street 1: | 2415 N GATEWAY AVE |
Practice Address - Street 2: | |
Practice Address - City: | HARRIMAN |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37748-8609 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-632-5122 |
Practice Address - Fax: | 865-632-5116 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-08 |
Last Update Date: | 2016-07-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Single Specialty |