Provider Demographics
NPI:1871650010
Name:MID STATE ONCOLOGY& HEMATOLOGY
Entity Type:Organization
Organization Name:MID STATE ONCOLOGY& HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-329-7870
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:SUITE 506
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-329-7870
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:SUITE 506
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-329-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000010750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3703746Medicare ID - Type Unspecified
A96663Medicare UPIN
TN0701760001Medicare NSC