Provider Demographics
NPI:1619186640
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
Authorized Official - Prefix:
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:865-862-0988
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:1410 TUSCULUM BLVD
Practice Address - Street 2:SUITE 2200
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4286
Practice Address - Country:US
Practice Address - Phone:423-639-0243
Practice Address - Fax:423-639-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDB2744OtherRR MEDICARE GROUP
TN3725737Medicaid
KY659431440Medicaid
TN3725737Medicaid