Provider Demographics
NPI:1962473405
Name:CANCER OUTREACH ASSOCIATES OF TENNESSEE, P.C.
Entity Type:Organization
Organization Name:CANCER OUTREACH ASSOCIATES OF TENNESSEE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:276-676-1860
Mailing Address - Street 1:104 ABINGDON PL
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5197
Mailing Address - Country:US
Mailing Address - Phone:276-676-1860
Mailing Address - Fax:276-628-2917
Practice Address - Street 1:1 PROFESSIONAL PARK DR
Practice Address - Street 2:MCPP #1, SUITE 18
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6587
Practice Address - Country:US
Practice Address - Phone:423-926-0063
Practice Address - Fax:423-926-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723247Medicare ID - Type UnspecifiedGROUP NUMBER