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	:	1508872169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE CANCER SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 10988
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37939-0988
Country	:	US
Telephone Number	:	865-862-0998
Fax Number	:	865-544-1861

Provider Business Practice Location Address
First Line	:	9430 PARK WEST BLVD
Second Line	:	SUITE 120
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4200
Country	:	US
Telephone Number	:	865-693-2255
Fax Number	:	865-691-7888

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/14/2016

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