Provider Demographics
NPI:1205921285
Name:SURGICAL ONCOLOGY ASSOCIATES
Entity type:Organization
Organization Name:SURGICAL ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-544-9422
Mailing Address - Street 1:1934 ALCOA HWY
Mailing Address - Street 2:STE 474
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1524
Mailing Address - Country:US
Mailing Address - Phone:865-544-9422
Mailing Address - Fax:
Practice Address - Street 1:9000 EXECUTIVE PARK DR
Practice Address - Street 2:C200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4685
Practice Address - Country:US
Practice Address - Phone:865-670-6132
Practice Address - Fax:865-670-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704057Medicaid
TN3704057Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER