MEDICARE: TENNESSEE CANCER SPECIALISTS PLLC

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	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1275803637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CANCER SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	900 E HILL AVE
Second Line	:	SUITE 230
City	:	KNOXVILLE
State	:	TN
Zip	:	37915-2566
Country	:	US
Telephone Number	:	865-862-3563
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	353 WORTH ST NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5074
Country	:	US
Telephone Number	:	423-339-0300
Fax Number	:	423-472-5687

Authorized Official
Title or Position	:	CHIEF MANAGER/PHYSICIAN
Name	:	MITCHELL D MARTIN
Credential	:	M.D.
Telephone Number	:	865-637-9330

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/03/2012

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