Healthcare Provider Details

I. General information

NPI: 1104873090
Provider Name (Legal Business Name): ALGIS PETRAS SIDRYS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

140 W 7TH ST
COOKEVILLE TN
38501-1726
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2497
  • Fax: 931-783-5757
Mailing address:
  • Phone: 931-783-5582
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number28008
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number28008
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: