Healthcare Provider Details

I. General information

NPI: 1356446298
Provider Name (Legal Business Name): EAST TENNESSEE HEMATOLOGY/ONCOLOGY ASSOC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N STATE OF FRANKLIN RD STE 401
JOHNSON CITY TN
37604-6008
US

IV. Provider business mailing address

PO BOX 3770
JOHNSON CITY TN
37602-3770
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-3611
  • Fax: 423-926-3073
Mailing address:
  • Phone: 423-926-3611
  • Fax: 423-926-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5883370001
License Number StateTN

VIII. Authorized Official

Name: WILLIAM R KINCAID
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-926-3611