Provider Demographics
NPI:1881734622
Name:UNIVERSITY ONCOLOGY AND HEMATOLOGY ASSO, PLLC
Entity type:Organization
Organization Name:UNIVERSITY ONCOLOGY AND HEMATOLOGY ASSO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEREN
Authorized Official - Suffix:
Authorized Official - Credentials:BA MT
Authorized Official - Phone:423-752-5004
Mailing Address - Street 1:979 E 3RD ST STE A0550
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-752-5004
Mailing Address - Fax:423-756-9009
Practice Address - Street 1:979 E 3RD ST STE A0550
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-752-5004
Practice Address - Fax:423-756-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712472Medicare ID - Type UnspecifiedGROUP # FOR A0550