MEDICARE: TENNESSEE HDR MEDICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		TN
2	261QX0203X	Radiation Oncology Clinic/Center		TN

General Provider Information

NPI Number	:	1275514697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE HDR MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	7551 DANNAHER WAY
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-4029
Country	:	US
Telephone Number	:	865-859-7020
Fax Number	:	865-859-3706

Provider Business Practice Location Address
First Line	:	7551 DANNAHER WAY
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-4029
Country	:	US
Telephone Number	:	865-859-7020
Fax Number	:	865-859-3706

Authorized Official
Title or Position	:	GOVERNOR AND COC
Name	:	MR. JACK M BRYAN
Credential	:
Telephone Number	:	865-859-1337

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	03/18/2008

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Directions to “TENNESSEE HDR MEDICAL SERVICES LLC ” Practice Location

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