Healthcare Provider Details

I. General information

NPI: 1689757866
Provider Name (Legal Business Name): TENNESSEE CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 PARKWEST BLVD STE 120
KNOXVILLE TN
37923
US

IV. Provider business mailing address

900 E HILL AVE STE 230
KNOXVILLE TN
37915-2566
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-2255
  • Fax: 865-691-7888
Mailing address:
  • Phone: 865-862-0998
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number705448
License Number StateTN

VIII. Authorized Official

Name: MITCHELL D MARTIN
Title or Position: CHIEF MANAGER
Credential: M.D.
Phone: 865-637-9330