Provider Demographics
NPI:1881880961
Name:COLUMBIA RADIATION ONCOLOGY
Entity type:Organization
Organization Name:COLUMBIA RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-396-5530
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-0968
Mailing Address - Country:US
Mailing Address - Phone:615-382-8863
Mailing Address - Fax:615-382-8056
Practice Address - Street 1:509 E BELL ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3059
Practice Address - Country:US
Practice Address - Phone:615-396-5530
Practice Address - Fax:615-382-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725076Medicare PIN